Provider Demographics
NPI:1659683506
Name:MICHIGAN CHIROPRACTIC PAIN CENTERS PLLC
Entity Type:Organization
Organization Name:MICHIGAN CHIROPRACTIC PAIN CENTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:CHUKWUGOZIE
Authorized Official - Last Name:OKONKWOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-470-4477
Mailing Address - Street 1:2021 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2246
Mailing Address - Country:US
Mailing Address - Phone:248-470-4477
Mailing Address - Fax:
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:STE 257
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:248-470-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F34045OtherBCBSM