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General NPI Number Information
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NPI Number | 1881920718
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Entity Type | Organization
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Legal Business Name | PRO CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 536 N OLD WOODWARD AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5375
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Country | US
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Telephone | 248-792-9736
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | BIRMINGHAM
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State | MI
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Zip | 48012-0220
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Country | US
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Telephone | 480-284-9072
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. RAYMOND JAMES HLLENBRAND
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Credential | DC
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Telephone | 480-284-9072
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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 | 2301005895
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License Number State | MI
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