Provider Demographics
NPI:1275072175
Name:DOWNRIVER SPINE MANAGEMENT CLINIC PLLC
Entity Type:Organization
Organization Name:DOWNRIVER SPINE MANAGEMENT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAYCHOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-406-2410
Mailing Address - Street 1:4828 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2914
Mailing Address - Country:US
Mailing Address - Phone:313-406-2410
Mailing Address - Fax:313-228-5294
Practice Address - Street 1:4828 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2914
Practice Address - Country:US
Practice Address - Phone:313-406-2410
Practice Address - Fax:313-228-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty