Provider Demographics
NPI:1093908436
Name:KAMITKO COLEMAN
Entity Type:Organization
Organization Name:KAMITKO COLEMAN
Other - Org Name:HEALTHY HEARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMITKO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-430-2402
Mailing Address - Street 1:16200 BURGESS
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4804
Mailing Address - Country:US
Mailing Address - Phone:734-430-2402
Mailing Address - Fax:248-864-8299
Practice Address - Street 1:16200 BURGESS
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4804
Practice Address - Country:US
Practice Address - Phone:734-430-2402
Practice Address - Fax:248-864-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315023764111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP49580Medicare PIN