Provider Demographics
NPI:1457911133
Name:1ST CHOICE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:1ST CHOICE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMZI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASERDEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-924-1234
Mailing Address - Street 1:24350 JOY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1265
Mailing Address - Country:US
Mailing Address - Phone:313-924-1234
Mailing Address - Fax:313-924-1239
Practice Address - Street 1:24350 JOY RD STE 1
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1265
Practice Address - Country:US
Practice Address - Phone:313-924-1234
Practice Address - Fax:313-924-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-16
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851842744Medicaid