Provider Demographics
NPI:1689827420
Name:DALE J KRETUNSKI D.C, P.C.
Entity Type:Organization
Organization Name:DALE J KRETUNSKI D.C, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KRETUNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO PT
Authorized Official - Phone:586-773-9530
Mailing Address - Street 1:16224 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1524
Mailing Address - Country:US
Mailing Address - Phone:586-773-9530
Mailing Address - Fax:
Practice Address - Street 1:16224 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1524
Practice Address - Country:US
Practice Address - Phone:586-773-9530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALE J KRETUNSKI D.C. P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E05021Medicare UPIN
MI0M78240Medicare UPIN