Provider Demographics
NPI:1851806582
Name:AUTHENTIC LIVING CENTER, INC.
Entity Type:Organization
Organization Name:AUTHENTIC LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-822-9253
Mailing Address - Street 1:2525 CROOKS ROAD
Mailing Address - Street 2:STE. #101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4733
Mailing Address - Country:US
Mailing Address - Phone:248-822-9253
Mailing Address - Fax:248-822-9134
Practice Address - Street 1:2525 CROOKS RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4733
Practice Address - Country:US
Practice Address - Phone:248-822-9253
Practice Address - Fax:248-822-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITP006128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty