Provider Demographics
NPI:1740336767
Name:MICHIGAN CHIROPRACTIC SPECIALISTS OF WATERFORD, P.C.
Entity type:Organization
Organization Name:MICHIGAN CHIROPRACTIC SPECIALISTS OF WATERFORD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:APFELBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-706-3428
Mailing Address - Street 1:1348 SCOTT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1578
Mailing Address - Country:US
Mailing Address - Phone:248-706-3428
Mailing Address - Fax:248-706-3437
Practice Address - Street 1:1348 SCOTT LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1578
Practice Address - Country:US
Practice Address - Phone:248-706-3428
Practice Address - Fax:248-706-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherFEDERAL TAX ID
MI0P27720Medicare PIN