MEDICARE: DR. JEFFREY CHARLES DUCHENE D.C.

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	111NX0100X	Occupational Health Chiropractor	2301005304	MI

General Provider Information

NPI Number	:	1528062080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CHARLES DUCHENE D.C.

Provider Business Mailing Address
First Line	:	19199 15 MILE RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-2508
Country	:	US
Telephone Number	:	586-791-5555
Fax Number	:

Provider Business Practice Location Address
First Line	:	19199 15 MILE RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-2508
Country	:	US
Telephone Number	:	586-791-5555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2005
Last Update Date	:	07/08/2007

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