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General NPI Number Information
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NPI Number | 1881779031
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Entity Type | Organization
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Legal Business Name | ADVANCED BACK SOLUTIONS
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 615 N MILL ST STE C
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City | PLYMOUTH
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State | MI
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Zip | 48170-1397
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Country | US
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Telephone | 734-437-7689
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Fax | 734-437-7699
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Provider Business Mailing Address
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Address Line | 615 N MILL ST STE C
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City | PLYMOUTH
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State | MI
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Zip | 48170-1397
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Country | US
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Telephone | 734-437-7689
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Fax | 734-437-7699
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN M VENERUS
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Credential | D.C.
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Telephone | 734-437-7689
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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 | 2301008605
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License Number State | MI
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