Provider Demographics
NPI:1235279928
Name:OKONKWOR, RAPHAEL CHIGOZIE (DC)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:CHIGOZIE
Last Name:OKONKWOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD STE 460
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3754
Mailing Address - Country:US
Mailing Address - Phone:248-644-6272
Mailing Address - Fax:248-644-6726
Practice Address - Street 1:23077 GREENFIELD RD STE 460
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3754
Practice Address - Country:US
Practice Address - Phone:248-644-6272
Practice Address - Fax:248-644-6276
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor