Provider Demographics
NPI:1134281561
Name:OBRIEN CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:OBRIEN CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-752-1515
Mailing Address - Street 1:143 W SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4657
Mailing Address - Country:US
Mailing Address - Phone:586-752-1515
Mailing Address - Fax:586-752-4211
Practice Address - Street 1:143 W SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-4657
Practice Address - Country:US
Practice Address - Phone:586-752-1515
Practice Address - Fax:586-752-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E05227OtherBCBSM INDIVIDUAL PROVIDER ID
MI2823492Medicaid
MI0E012690OtherBCBSM PROVIDER NUMBER
MI2823492Medicaid
MI0N90950Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
MI2823492Medicaid