MEDICARE: UNIVERSAL HEALTH GROUP, INC.

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	2301008804	MI

General Provider Information

NPI Number	:	1588832653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL HEALTH GROUP, INC.

Provider Business Mailing Address
First Line	:	5761 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2270
Country	:	US
Telephone Number	:	248-626-6892
Fax Number	:	248-855-2477

Provider Business Practice Location Address
First Line	:	5761 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2270
Country	:	US
Telephone Number	:	248-626-6892
Fax Number	:	248-855-2477

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. SCOTT PHILIP ZACK
Credential	:	D.C.
Telephone Number	:	248-626-6892

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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