=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700686417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCORDE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 E LONG LAKE RD STE 101
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48085-4974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-729-7180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1120 E LONG LAKE RD STE 101
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48085-4974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-729-7180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | EMMA BELLAND
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 248-729-7180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------