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General NPI Number Information
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NPI Number | 1962679670
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Entity Type | Organization
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Legal Business Name | SOUTH HAVEN CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 1210 PHOENIX ST SUITE 10
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City | SOUTH HAVEN
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State | MI
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Zip | 49090-7913
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Country | US
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Telephone | 269-639-7200
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Fax | 269-621-2556
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Provider Business Mailing Address
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Address Line | PO BOX 621
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City | HARTFORD
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State | MI
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Zip | 49057-0621
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Country | US
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Telephone | 269-621-3800
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Fax | 269-621-2556
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. AHAD E. LOTFI
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Credential | D.C.
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Telephone | 269-639-7200
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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 | 2301006100
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License Number State | MI
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