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General NPI Number Information
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NPI Number | 1871668400
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Entity Type | Organization
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Legal Business Name | BACK IN LINE CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 712 E. 9 MILE RD
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City | HAZEL PARK
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State | MI
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Zip | 48030
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Country | US
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Telephone | 248-556-5890
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Fax | 248-556-5891
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | HAZEL PARK
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State | MI
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Zip | 48030-0365
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Country | US
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Telephone | 313-768-8858
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMED SALEH
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Credential | D.C.
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Telephone | 313-768-8858
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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 | 2301008526
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License Number State | MI
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