Provider Demographics
NPI:1548566078
Name:CHIROPRACTORS REHABILITATION GROUP
Entity Type:Organization
Organization Name:CHIROPRACTORS REHABILITATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-353-2225
Mailing Address - Street 1:24725 W 12 MILE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1801
Mailing Address - Country:US
Mailing Address - Phone:248-353-2225
Mailing Address - Fax:
Practice Address - Street 1:24725 W 12 MILE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1801
Practice Address - Country:US
Practice Address - Phone:248-353-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty