Provider Demographics
NPI:1629023353
Name:WARE, DEMERIUS LATELL (DC)
Entity Type:Individual
Prefix:DR
First Name:DEMERIUS
Middle Name:LATELL
Last Name:WARE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30827 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-751-8984
Mailing Address - Fax:586-751-5221
Practice Address - Street 1:30827 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-751-8984
Practice Address - Fax:586-751-5221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM40520Medicare ID - Type Unspecified
MIU66681Medicare UPIN