Provider Demographics
NPI:1922126861
Name:IKWECHEGH, SOLOMON I (BSC, BS, DC)
Entity Type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:I
Last Name:IKWECHEGH
Suffix:
Gender:M
Credentials:BSC, BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3591
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3591
Mailing Address - Country:US
Mailing Address - Phone:313-272-1777
Mailing Address - Fax:313-272-1777
Practice Address - Street 1:15800 W MCNICHOLS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3566
Practice Address - Country:US
Practice Address - Phone:313-272-1777
Practice Address - Fax:313-272-1777
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP14930Medicare ID - Type Unspecified