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General NPI Number Information
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NPI Number | 1992109672
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Entity Type | Organization
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Legal Business Name | FAMILY TREE CHIROPRACTIC
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 2302 PACKARD RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1821
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Country | US
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Telephone | 734-434-9835
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Fax | 734-434-9836
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Provider Business Mailing Address
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Address Line | 1996 APPLEBROOK DR
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48382-1491
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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 | OWNER
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Name | SIIRI KRYGOWSKI
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Credential | D.C.
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Telephone | 586-453-3088
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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 | 2301010194
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License Number State | MI
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