Provider Demographics
NPI:1518129279
Name:MIROWSKI CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MIROWSKI CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-777-1030
Mailing Address - Street 1:30838 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6856
Mailing Address - Country:US
Mailing Address - Phone:586-777-1031
Mailing Address - Fax:
Practice Address - Street 1:30838 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6856
Practice Address - Country:US
Practice Address - Phone:586-777-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM006964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E053370OtherBCBS
MION14800Medicare PIN