Provider Demographics
NPI:1962650903
Name:DALE J KRETUNSKI DC PC
Entity Type:Organization
Organization Name:DALE J KRETUNSKI DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KRETUNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:586-773-9530
Mailing Address - Street 1:16224 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1524
Mailing Address - Country:US
Mailing Address - Phone:586-773-9530
Mailing Address - Fax:586-773-7765
Practice Address - Street 1:16224 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1524
Practice Address - Country:US
Practice Address - Phone:586-773-9530
Practice Address - Fax:586-773-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004970111N00000X
MI5501002214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM78240Medicare UPIN
MIT33119Medicare UPIN