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General NPI Number Information
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NPI Number | 1891912291
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Entity Type | Organization
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Legal Business Name | COUSINEAU CHIROPRACTIC LIFE CENTER P.C.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 14550 KING RD
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City | RIVERVIEW
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State | MI
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Zip | 48193-7963
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Country | US
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Telephone | 734-479-1880
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Fax | 734-479-4810
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Provider Business Mailing Address
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Address Line | 14550 KING RD
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City | RIVERVIEW
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State | MI
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Zip | 48193-7963
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Country | US
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Telephone | 734-479-1880
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Fax | 734-479-4810
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Authorized Official
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Title or Position | BILLER
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Name | JAN K BENORE
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Credential |
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Telephone | 734-479-1880
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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 |
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License Number State |
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