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General NPI Number Information
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NPI Number | 1861575169
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Entity Type | Organization
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Legal Business Name | BRANDON CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 70 ORTONVILLE RD BRANDON CHIROPRACTIC CENTER
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City | ORTONVILLE
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State | MI
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Zip | 48462
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Country | US
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Telephone | 248-627-9595
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Fax | 248-627-9379
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Provider Business Mailing Address
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Address Line | 70 ORTONVILLE RD BRANDON CHIROPRACTIC CENTER
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City | ORTONVILLE
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State | MI
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Zip | 48462
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Country | US
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Telephone | 248-627-9595
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Fax | 248-627-9379
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY A STARK
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Credential | DC
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Telephone | 248-627-9595
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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 | JS007228
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License Number State |
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