MEDICARE: SOMERSET THERAPY CENTER

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	2301007140	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950F340390	OTHER	MI	BCBS MI

General Provider Information

NPI Number	:	1992971493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMERSET THERAPY CENTER

Provider Business Mailing Address
First Line	:	1777 AXTELL DR STE 100
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-4400
Country	:	US
Telephone Number	:	248-816-6776
Fax Number	:	248-816-6766

Provider Business Practice Location Address
First Line	:	1777 AXTELL DR STE 100
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-4400
Country	:	US
Telephone Number	:	248-816-6776
Fax Number	:	248-816-6766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN EDWARD MOUSSAWER
Credential	:
Telephone Number	:	248-816-6776

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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Directions to “SOMERSET THERAPY CENTER ” Practice Location

Language	Start Address	Practice Location

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