Provider Demographics
NPI:1013956804
Name:UTICA CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:UTICA CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:DYBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-739-6080
Mailing Address - Street 1:45200 STERRITT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5844
Mailing Address - Country:US
Mailing Address - Phone:586-739-6080
Mailing Address - Fax:
Practice Address - Street 1:45200 STERRITT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5844
Practice Address - Country:US
Practice Address - Phone:586-739-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2090221Medicaid
MIT97162Medicare UPIN
MI0E07655Medicare ID - Type Unspecified