Provider Demographics
NPI:1083058911
Name:DEARBORN SPINE CENTER PLLC
Entity Type:Organization
Organization Name:DEARBORN SPINE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULDAYEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-841-1470
Mailing Address - Street 1:9925 DIX
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1593
Mailing Address - Country:US
Mailing Address - Phone:313-841-1470
Mailing Address - Fax:
Practice Address - Street 1:9925 DIX
Practice Address - Street 2:SUITE 102
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1593
Practice Address - Country:US
Practice Address - Phone:313-841-1470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty