=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912028796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC ASSOCIATES OF MICHIGAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31850 SCHOENHERR RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48088-1983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-293-4440
-----------------------------------------------------
Fax | 586-293-0840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10074 BORGMAN AVE
-----------------------------------------------------
City | HUNTINGTON WOODS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48070-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-541-1649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. LANNY BERT LIPSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 586-293-4440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------