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General NPI Number Information
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NPI Number | 1710129796
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Entity Type | Organization
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Legal Business Name | WHOLE BODY HEALTH CLINIC
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 27041 SOUTHFIELD RD SUITE 101
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-3459
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Country | US
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Telephone | 248-931-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 27041 SOUTHFIELD RD SUITE 101
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-3459
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Country | US
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Telephone | 248-931-1711
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. SUMMER ROSE FAKHOURI
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Credential | D.C.
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Telephone | 248-931-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009437
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License Number State | MI
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