=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861660821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC HEALTH CENTER OF BRIGHTON PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2008
-----------------------------------------------------
Last Update Date | 07/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8143 GRAND RIVER RD SUITE 2
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-9406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-229-5591
-----------------------------------------------------
Fax | 810-229-0543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8143 GRAND RIVER RD SUITE 2
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-9406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-229-5591
-----------------------------------------------------
Fax | 810-229-0543
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. STEPHAN J SMITH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 810-229-5591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2301007830
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------