Provider Demographics
NPI:1841420957
Name:ECLECTIC CHIROPRACTIC REHAB
Entity Type:Organization
Organization Name:ECLECTIC CHIROPRACTIC REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUBIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-312-9249
Mailing Address - Street 1:1777 AXTELL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-312-9249
Mailing Address - Fax:248-281-7010
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-312-9249
Practice Address - Fax:248-281-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty