Provider Demographics
NPI:1033878038
Name:GREATLAKES CHIROPRACTIC
Entity Type:Organization
Organization Name:GREATLAKES CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-939-1003
Mailing Address - Street 1:4105 METRO PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7503
Mailing Address - Country:US
Mailing Address - Phone:586-939-1003
Mailing Address - Fax:586-939-3862
Practice Address - Street 1:4105 METRO PKWY STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7503
Practice Address - Country:US
Practice Address - Phone:586-939-1003
Practice Address - Fax:586-939-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty