MEDICARE: ABC BACK & NECK CARE

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	111NN1001X	Nutrition Chiropractor
2	111NR0200X	Radiology Chiropractor	2301007718	MI
3	111N00000X	Chiropractor	2301007718	MI

General Provider Information

NPI Number	:	1992840136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC BACK & NECK CARE

Provider Business Mailing Address
First Line	:	3283 W SILVER LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1369
Country	:	US
Telephone Number	:	810-750-0222
Fax Number	:	810-750-6222

Provider Business Practice Location Address
First Line	:	3283 W SILVER LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1369
Country	:	US
Telephone Number	:	810-750-0222
Fax Number	:	810-750-6222

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY J SUSZKO
Credential	:	DC
Telephone Number	:	810-750-0222

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/28/2007

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Directions to “ABC BACK & NECK CARE ” Practice Location

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