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General NPI Number Information
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NPI Number | 1720564149
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Entity Type | Organization
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Legal Business Name | GREAT LAKES CHIROPRACTIC & MOVEMENT PLLC
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 4215 MILLER RD # A8
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City | FLINT
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State | MI
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Zip | 48507-1299
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Country | US
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Telephone | 810-234-5431
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 MILLER RD # A8
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City | FLINT
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State | MI
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Zip | 48507-1299
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Country | US
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Telephone | 810-234-5431
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JON DALE MOREY
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Credential | DC
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Telephone | 810-234-5431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 2301009577
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License Number State | MI
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