Provider Demographics
NPI:1871685636
Name:CARUSO CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:CARUSO CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-693-4800
Mailing Address - Street 1:25 S LAPEER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3167
Mailing Address - Country:US
Mailing Address - Phone:248-693-4800
Mailing Address - Fax:248-693-3539
Practice Address - Street 1:25 S LAPEER ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3167
Practice Address - Country:US
Practice Address - Phone:248-693-4800
Practice Address - Fax:248-693-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005487111N00000X
MI2301009859111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4803194Medicaid
MI2712608Medicaid
MIN92180005OtherDR. BRAD SABO - PTAN
MI2712608Medicaid
MI4803194Medicaid
MI0F35301Medicare ID - Type UnspecifiedSAM CARUSO
MIN92180005OtherDR. BRAD SABO - PTAN
MI0F35301Medicare ID - Type UnspecifiedSAM CARUSO
MIN92180003Medicare ID - Type UnspecifiedWILLIAM PURDY II
MI4803194Medicaid