MEDICARE: FLOURISH FAMILY CHIROPRACTIC, PLLC

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	2301010588	MI

General Provider Information

NPI Number	:	1396244513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOURISH FAMILY CHIROPRACTIC, PLLC

Provider Business Mailing Address
First Line	:	51309 MOUND RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4344
Country	:	US
Telephone Number	:	810-892-3339
Fax Number	:

Provider Business Practice Location Address
First Line	:	51309 MOUND RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4344
Country	:	US
Telephone Number	:	810-892-3339
Fax Number	:	586-323-7903

Authorized Official
Title or Position	:	OWNER/ CHIROPRACTOR
Name	:	DR. LISA ANN LUPO
Credential	:	DC
Telephone Number	:	810-892-3339

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	02/16/2018

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