Provider Demographics
NPI:1902209042
Name:RENEWED MOBILITY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:RENEWED MOBILITY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:APRAHAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-536-4680
Mailing Address - Street 1:40484 COACHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3274
Mailing Address - Country:US
Mailing Address - Phone:248-924-2638
Mailing Address - Fax:248-924-2638
Practice Address - Street 1:9329 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4622
Practice Address - Country:US
Practice Address - Phone:734-536-4680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558790196Medicare UPIN