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General NPI Number Information
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NPI Number | 1841682630
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Entity Type | Organization
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Legal Business Name | QUALITY CHIRO CARE LLC
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 20180 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5412
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Country | US
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Telephone | 248-223-9584
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Fax | 248-223-9586
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Provider Business Mailing Address
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Address Line | 20180 W 12 MILE RD SUITE 300
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5412
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Country | US
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Telephone | 248-223-9584
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Fax | 248-223-9586
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Authorized Official
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Title or Position | MANAGER
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Name | WILLIAM BOGGS
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Credential | M.D
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Telephone | 248-223-9584
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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 | 2301007574
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License Number State | MI
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