MEDICARE: ADVANCED CHIROPRACTIC CARE CENTER, P.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
1	111N00000X	Chiropractor	2301004819	MI

General Provider Information

NPI Number	:	1801849492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC CARE CENTER, P.C.

Provider Business Mailing Address
First Line	:	51735 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4451
Country	:	US
Telephone Number	:	586-731-8840
Fax Number	:	586-731-9550

Provider Business Practice Location Address
First Line	:	51735 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4451
Country	:	US
Telephone Number	:	586-731-8840
Fax Number	:	586-731-9550

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KARL R JOHNSON
Credential	:	D.C.
Telephone Number	:	586-731-8840

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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