MEDICARE: TLC CHIROPRACTIC PC

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	2301008361	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ON58940	OTHER	MI	BLUE CROSS OF MICHIGAN
2	0H254610	OTHER	MI	BLUE CROSS BLUE SHIELD MI

General Provider Information

NPI Number	:	1922058387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	19601 FARMINGTON RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-1431
Country	:	US
Telephone Number	:	734-664-0339
Fax Number	:	734-261-5109

Provider Business Practice Location Address
First Line	:	31580 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1805
Country	:	US
Telephone Number	:	734-664-0339
Fax Number	:	734-261-5109

Authorized Official
Title or Position	:	PRESIDENT TLC PC
Name	:	DR. CAROL ANN FISCHER
Credential	:	DC
Telephone Number	:	734-664-0339

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/10/2014

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