MEDICARE: A1 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

General Provider Information

NPI Number	:	1609979780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A1 CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	3825 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-4100
Country	:	US
Telephone Number	:	810-982-6115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 24TH AVE
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-4100
Country	:	US
Telephone Number	:	810-982-6115
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SOLOMON L COGAN
Credential	:	D.C.
Telephone Number	:	248-471-5554

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/22/2020

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