MEDICARE: ERIC MINTZ DC

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	EM007699	MI

General Provider Information

NPI Number	:	1881750735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MINTZ DC

Provider Business Mailing Address
First Line	:	5600 W MAPLE RD
Second Line	:	SUITE A110
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3704
Country	:	US
Telephone Number	:	248-737-9494
Fax Number	:	248-865-2549

Provider Business Practice Location Address
First Line	:	5600 W MAPLE RD
Second Line	:	SUITE A110
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3704
Country	:	US
Telephone Number	:	248-737-9494
Fax Number	:	248-865-2549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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Directions to “ ERIC MINTZ DC” Practice Location

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