Provider Demographics
NPI:1851556799
Name:DISCOVER CHIROPRACTIC CLINIC,PLC
Entity Type:Organization
Organization Name:DISCOVER CHIROPRACTIC CLINIC,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PASSALACQUA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LCP,DPHCA
Authorized Official - Phone:248-879-5540
Mailing Address - Street 1:5909 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3867
Mailing Address - Country:US
Mailing Address - Phone:248-879-5540
Mailing Address - Fax:
Practice Address - Street 1:5909 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3867
Practice Address - Country:US
Practice Address - Phone:248-879-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35270OtherBLUECROSSBLUESHIELD
MI0F35270OtherBLUECROSSBLUESHIELD