Provider Demographics
NPI:1407991789
Name:CLINTON TWP SPINE CARE PC
Entity Type:Organization
Organization Name:CLINTON TWP SPINE CARE PC
Other - Org Name:CLINTON TWP SPINE CARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-397-3590
Mailing Address - Street 1:43475 DALCOMA DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3591
Mailing Address - Country:US
Mailing Address - Phone:810-397-3590
Mailing Address - Fax:
Practice Address - Street 1:43475 DALCOMA DR
Practice Address - Street 2:SUITE 145
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3591
Practice Address - Country:US
Practice Address - Phone:810-397-3590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 111NN1001X
MI2301004922111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty