Provider Demographics
NPI:1174665103
Name:MIROWSKI, RICHARD J (PC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MIROWSKI
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37211 HARPER AVE
Mailing Address - Street 2:STE 9B
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3074
Mailing Address - Country:US
Mailing Address - Phone:586-668-4234
Mailing Address - Fax:
Practice Address - Street 1:37211 HARPER AVE
Practice Address - Street 2:STE 9B
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3074
Practice Address - Country:US
Practice Address - Phone:586-668-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N14800Medicare PIN