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General NPI Number Information
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NPI Number | 1790962454
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Entity Type | Organization
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Legal Business Name | DYNAMIC CHIROPRACTIC P. C.
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 555 BARCLAY CIR SUITE 140
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4555
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Country | US
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Telephone | 248-299-6911
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Fax |
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Provider Business Mailing Address
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Address Line | 555 BARCLAY CIR SUITE 140
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4555
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Country | US
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Telephone | 248-299-6911
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ONDRE JACQUES
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Credential | DC
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Telephone | 248-689-9413
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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 | OJ008019
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License Number State | MI
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