MEDICARE: MICHIGAN COMPLETE CHIROPRACTIC & REHAB., PLC

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

General Provider Information

NPI Number	:	1154961514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN COMPLETE CHIROPRACTIC & REHAB., PLC

Provider Business Mailing Address
First Line	:	5958 N CANTON CENTER RD STE 300
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2766
Country	:	US
Telephone Number	:	734-212-5828
Fax Number	:	734-212-5827

Provider Business Practice Location Address
First Line	:	5958 N CANTON CENTER RD STE 300
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2766
Country	:	US
Telephone Number	:	734-212-5828
Fax Number	:	734-212-5827

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB BALDWIN
Credential	:	DC
Telephone Number	:	734-212-5828

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	07/09/2020

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