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General NPI Number Information
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NPI Number | 1942771589
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Entity Type | Organization
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Legal Business Name | RESTORATION CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 6825 HANNA LAKE AVE SE
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City | CALEDONIA
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State | MI
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Zip | 49316-9118
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Country | US
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Telephone | 586-596-2370
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Fax | 989-548-6033
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Provider Business Mailing Address
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Address Line | 6825 HANNA LAKE AVE SE
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City | CALEDONIA
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State | MI
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Zip | 49316-9118
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Country | US
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Telephone | 586-596-2370
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Fax | 989-548-6033
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | ANNE M MOCERI
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Credential |
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Telephone | 586-596-2370
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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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