Provider Demographics
NPI:1639347602
Name:FIREBERG CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FIREBERG CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FIREBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-543-9380
Mailing Address - Street 1:23507 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1408
Mailing Address - Country:US
Mailing Address - Phone:248-543-9380
Mailing Address - Fax:248-543-9381
Practice Address - Street 1:23507 JOHN R RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1408
Practice Address - Country:US
Practice Address - Phone:248-543-9380
Practice Address - Fax:248-543-9381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty