Provider Demographics
NPI:1417593963
Name:RECOVERED CHIROPRACTIC
Entity Type:Organization
Organization Name:RECOVERED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-410-0187
Mailing Address - Street 1:3845 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1171
Mailing Address - Country:US
Mailing Address - Phone:517-410-0187
Mailing Address - Fax:
Practice Address - Street 1:5140 HIGHLAND RD # 1912
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1912
Practice Address - Country:US
Practice Address - Phone:517-410-0187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center