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General NPI Number Information
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NPI Number | 1770076747
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Entity Type | Organization
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Legal Business Name | NICK T BLEGGI, PC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 28455 SOUTHFIELD RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2819
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Country | US
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Telephone | 248-559-2959
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Fax |
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Provider Business Mailing Address
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Address Line | 28455 SOUTHFIELD RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2819
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Country | US
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Telephone | 248-559-2959
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JULIENNE RENEE BLEGGI
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Credential |
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Telephone | 248-559-2959
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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 | 2301300307
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License Number State | MI
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