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NPI Code Detail

MEDICARE: DELTA CHIROPRACTIC CENTER,P.L.L.C.

MEDICARE: DELTA CHIROPRACTIC CENTER,P.L.L.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
1111N00000XChiropractor2301008023MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2950B950020OTHERMIBCBS PIN#

General Provider Information

NPI Number : 1700099181
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELTA CHIROPRACTIC CENTER,P.L.L.C.
Provider Business Mailing Address
First Line : 222 N MILL ST
Second Line :
City : SAINT LOUIS
State : MI
Zip : 48880-1523
Country : US
Telephone Number : 989-681-4107
Fax Number : 989-681-3628
Provider Business Practice Location Address
First Line : 222 N MILL ST
Second Line :
City : SAINT LOUIS
State : MI
Zip : 48880-1523
Country : US
Telephone Number : 989-681-4107
Fax Number : 989-681-3628
Authorized Official
Title or Position : PRESIDENT
Name : AHMAD ZIA KHORRAMI
Credential : D.C.
Telephone Number : 989-681-4107
Provider Enumeration Date : 05/08/2007
Last Update Date : 02/26/2015

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