Provider Demographics
NPI:1497762231
Name:COE, MARY CHARLOTTE (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHARLOTTE
Last Name:COE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHARLOTTE
Other - Last Name:MILOSTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2400 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3551
Mailing Address - Country:US
Mailing Address - Phone:248-360-4333
Mailing Address - Fax:248-360-9457
Practice Address - Street 1:2400 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3551
Practice Address - Country:US
Practice Address - Phone:248-360-4333
Practice Address - Fax:248-360-9457
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor