Provider Demographics
NPI:1992840136
Name:ABC BACK & NECK CARE
Entity Type:Organization
Organization Name:ABC BACK & NECK CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUSZKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-750-0222
Mailing Address - Street 1:3283 W SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1369
Mailing Address - Country:US
Mailing Address - Phone:810-750-0222
Mailing Address - Fax:810-750-6222
Practice Address - Street 1:3283 W SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1369
Practice Address - Country:US
Practice Address - Phone:810-750-0222
Practice Address - Fax:810-750-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007718111N00000X, 111NR0200X
111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty