Provider Demographics
NPI:1003119710
Name:FERNDALE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:FERNDALE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:HYON
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-399-9355
Mailing Address - Street 1:22540 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1841
Mailing Address - Country:US
Mailing Address - Phone:248-399-9355
Mailing Address - Fax:248-399-8644
Practice Address - Street 1:22540 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1841
Practice Address - Country:US
Practice Address - Phone:248-399-9355
Practice Address - Fax:248-399-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI2301009012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty