Provider Demographics
NPI:1497019343
Name:FLORES CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:FLORES CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:734-246-5488
Mailing Address - Street 1:1642 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6104
Mailing Address - Country:US
Mailing Address - Phone:734-246-5488
Mailing Address - Fax:734-246-5490
Practice Address - Street 1:1642 EUREKA RD
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6104
Practice Address - Country:US
Practice Address - Phone:734-246-5488
Practice Address - Fax:734-246-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230005096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3028168Medicaid
MI3028168Medicaid
0H25241Medicare PIN