MEDICARE: FACCA CHIROPRACTIC CLINIC

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	2301004625	MI

General Provider Information

NPI Number	:	1710174917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACCA CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	2715 W WEBSTER RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3700
Country	:	US
Telephone Number	:	248-545-1550
Fax Number	:	248-545-2327

Provider Business Practice Location Address
First Line	:	2715 W WEBSTER RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3700
Country	:	US
Telephone Number	:	248-545-1550
Fax Number	:	248-545-2327

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT ROSSIT FACCA
Credential	:	D.C.
Telephone Number	:	248-545-1550

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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