Provider Demographics
NPI:1023414851
Name:OAKLAND SPORTS CHIROPRACTIC
Entity type:Organization
Organization Name:OAKLAND SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:CRYSTAL
Authorized Official - Last Name:MOSURE-JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-783-7169
Mailing Address - Street 1:425 N PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3189
Mailing Address - Country:US
Mailing Address - Phone:248-783-7169
Mailing Address - Fax:
Practice Address - Street 1:425 N PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3189
Practice Address - Country:US
Practice Address - Phone:248-783-7169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009849261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center