Provider Demographics
NPI:1033279427
Name:ROYAL OAK CHIROPRACTIC CLINIC P C
Entity Type:Organization
Organization Name:ROYAL OAK CHIROPRACTIC CLINIC P C
Other - Org Name:ROYAL OAK CHIROPRACTIC CLINIC P C
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:MANELA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-544-2400
Mailing Address - Street 1:1010 N CAMPBELL
Mailing Address - Street 2:STE 5
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067
Mailing Address - Country:US
Mailing Address - Phone:248-544-2400
Mailing Address - Fax:248-544-3079
Practice Address - Street 1:28817 WOODWARD AVE STE 5
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0915
Practice Address - Country:US
Practice Address - Phone:248-544-2400
Practice Address - Fax:248-544-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHM005424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F328740OtherBLUE CROSS BLUE SHIELD
MI1959191Medicaid
MI0F35288Medicare ID - Type Unspecified