Provider Demographics
NPI:1457763773
Name:MICHIGAN SPINE MANAGEMENT CLINIC PLC
Entity Type:Organization
Organization Name:MICHIGAN SPINE MANAGEMENT CLINIC PLC
Other - Org Name:MICHIGAN SPINE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:RAYCHOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-406-2410
Mailing Address - Street 1:22350 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2421
Mailing Address - Country:US
Mailing Address - Phone:313-406-2410
Mailing Address - Fax:313-406-6484
Practice Address - Street 1:22350 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2421
Practice Address - Country:US
Practice Address - Phone:313-406-2410
Practice Address - Fax:313-406-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty