Provider Demographics
NPI:1043752629
Name:JWAD CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:JWAD CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JWAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-885-1581
Mailing Address - Street 1:5378 W DOHERTY ST
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2708
Mailing Address - Country:US
Mailing Address - Phone:248-885-1581
Mailing Address - Fax:
Practice Address - Street 1:5378 W DOHERTY ST
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2708
Practice Address - Country:US
Practice Address - Phone:248-885-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010442111N00000X
MI171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty