Provider Demographics
NPI:1083157184
Name:MOTOR CITY MOBILE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOTOR CITY MOBILE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-537-4000
Mailing Address - Street 1:27209 LAHSER RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8401
Mailing Address - Country:US
Mailing Address - Phone:248-537-4000
Mailing Address - Fax:248-594-7775
Practice Address - Street 1:27209 LAHSER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8401
Practice Address - Country:US
Practice Address - Phone:248-537-4000
Practice Address - Fax:248-594-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010498251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health