Provider Demographics
NPI:1831315803
Name:THE SANCTUARY CHIROPRACTIC AND WELLNESS SPA
Entity Type:Organization
Organization Name:THE SANCTUARY CHIROPRACTIC AND WELLNESS SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:JARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-421-7100
Mailing Address - Street 1:35275 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1455
Mailing Address - Country:US
Mailing Address - Phone:734-421-7100
Mailing Address - Fax:734-421-7103
Practice Address - Street 1:35275 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1455
Practice Address - Country:US
Practice Address - Phone:734-421-7100
Practice Address - Fax:734-421-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P44660Medicare PIN