Provider Demographics
NPI:1851061931
Name:DETROIT SPINE & WELLNESS PC
Entity Type:Organization
Organization Name:DETROIT SPINE & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DASSOUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-645-0930
Mailing Address - Street 1:1126 HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-3180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16323 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3702
Practice Address - Country:US
Practice Address - Phone:313-645-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty