Provider Demographics
NPI:1588822746
Name:ARBOR PARK CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:ARBOR PARK CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:OMEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:734-434-8881
Mailing Address - Street 1:4940 W CLARK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-0860
Mailing Address - Country:US
Mailing Address - Phone:734-434-8881
Mailing Address - Fax:
Practice Address - Street 1:4940 W CLARK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-0860
Practice Address - Country:US
Practice Address - Phone:734-434-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN2814001Medicare PIN
U93609Medicare UPIN