Provider Demographics
NPI:1003962143
Name:NEW GRACE SPINAL REHABILITATION CENTER
Entity Type:Organization
Organization Name:NEW GRACE SPINAL REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR (OWNER)
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-548-2460
Mailing Address - Street 1:PO BOX 381008
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0075
Mailing Address - Country:US
Mailing Address - Phone:248-548-2460
Mailing Address - Fax:248-548-4387
Practice Address - Street 1:10450 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2914
Practice Address - Country:US
Practice Address - Phone:248-548-2460
Practice Address - Fax:248-548-4387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P26630Medicare ID - Type Unspecified
MIMM005997Medicare UPIN