MEDICARE: COMMUNITY CHIROPRACTIC & WELLNESS CENTER 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	2301005305	MI

General Provider Information

NPI Number	:	1720468374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CHIROPRACTIC & WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	2352 S COMMERCE RD
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-2128
Country	:	US
Telephone Number	:	248-960-0520
Fax Number	:	248-438-5463

Provider Business Practice Location Address
First Line	:	2352 S COMMERCE RD
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-2128
Country	:	US
Telephone Number	:	248-960-0520
Fax Number	:	248-438-5463

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	PAUL ECKLEY
Credential	:	D.C.
Telephone Number	:	248-960-0520

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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