MEDICARE: MAIN STREET CHIROPRACTIC AND REHAB 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	2301010680	MI

General Provider Information

NPI Number	:	1710477294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIN STREET CHIROPRACTIC AND REHAB PLLC

Provider Business Mailing Address
First Line	:	243 MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2643
Country	:	US
Telephone Number	:	734-699-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2643
Country	:	US
Telephone Number	:	734-699-6600
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. ERIC JOSEPH CONNER
Credential	:	DC
Telephone Number	:	734-699-6600

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	05/10/2018

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Directions to “MAIN STREET CHIROPRACTIC AND REHAB PLLC ” Practice Location

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