Provider Demographics
NPI:1205035417
Name:CHIROPRACTIC AND NUTRITIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC AND NUTRITIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-380-5680
Mailing Address - Street 1:18600 NORTHVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3544
Mailing Address - Country:US
Mailing Address - Phone:248-380-5680
Mailing Address - Fax:248-380-5681
Practice Address - Street 1:18600 NORTHVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3544
Practice Address - Country:US
Practice Address - Phone:248-380-5680
Practice Address - Fax:248-380-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H227280OtherBLUE CROSS BLUE SHIELD OF
MI950H227280OtherBLUE CROSS BLUE SHIELD OF
MIV00069Medicare UPIN