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General NPI Number Information
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NPI Number | 1942607106
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Entity Type | Organization
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Legal Business Name | ROCHESTER CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 900 N MAIN ST
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City | ROCHESTER
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State | MI
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Zip | 48307-1432
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Country | US
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Telephone | 248-656-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N MAIN ST
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City | ROCHESTER
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State | MI
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Zip | 48307-1432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JESSICA DYSARCZYK
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Credential |
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Telephone | 248-656-1011
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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 | 2301010095
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License Number State | MI
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