MEDICARE: MICHIGAN SPECIFIC CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	AR007188	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950F38878	OTHER	MI	BCBS GROUP NUMBER
2	143545301736	OTHER	MI	PPOM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	950F327350	OTHER	MI	BCBS INDIVIDUAL

General Provider Information

NPI Number	:	1073725818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN SPECIFIC CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3396 E WEST MAPLE RD
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48390-3807
Country	:	US
Telephone Number	:	248-960-3599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3396 E WEST MAPLE RD
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48390-3807
Country	:	US
Telephone Number	:	248-960-3599
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW ROBERTS
Credential	:	D.C.
Telephone Number	:	248-960-3599

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	01/20/2011

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Directions to “MICHIGAN SPECIFIC CHIROPRACTIC ” Practice Location

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