Provider Demographics
NPI:1659928612
Name:POINTES CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:POINTES CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-201-7228
Mailing Address - Street 1:660 COOK RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2710
Mailing Address - Country:US
Mailing Address - Phone:586-201-7228
Mailing Address - Fax:
Practice Address - Street 1:15761 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3479
Practice Address - Country:US
Practice Address - Phone:313-885-3500
Practice Address - Fax:313-885-3843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700854312OtherBLUE CARE NETWORK
MI2301008562OtherSTATE LICENSE