Provider Demographics
NPI:1467723783
Name:REDFORD SPINAL CARE PC
Entity Type:Organization
Organization Name:REDFORD SPINAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:SALAME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-433-1251
Mailing Address - Street 1:25958 W 6 MILE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2213
Mailing Address - Country:US
Mailing Address - Phone:313-766-4888
Mailing Address - Fax:313-766-4890
Practice Address - Street 1:25958 W 6 MILE RD STE 201
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2213
Practice Address - Country:US
Practice Address - Phone:313-766-4888
Practice Address - Fax:313-766-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008475111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty