Provider Demographics
NPI:1710129796
Name:WHOLE BODY HEALTH CLINIC
Entity Type:Organization
Organization Name:WHOLE BODY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-931-1711
Mailing Address - Street 1:27041 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3459
Mailing Address - Country:US
Mailing Address - Phone:248-931-1711
Mailing Address - Fax:
Practice Address - Street 1:27041 SOUTHFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-3459
Practice Address - Country:US
Practice Address - Phone:248-931-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty