Provider Demographics
NPI:1558323923
Name:SIGNATURE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SIGNATURE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LORENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-288-3280
Mailing Address - Street 1:PO BOX 4720
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-4720
Mailing Address - Country:US
Mailing Address - Phone:248-288-3280
Mailing Address - Fax:248-288-3282
Practice Address - Street 1:909 W MAPLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017
Practice Address - Country:US
Practice Address - Phone:248-288-3280
Practice Address - Fax:248-288-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIML002909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3294146Medicaid
MI3294146Medicaid