Provider Demographics
NPI:1700099181
Name:DELTA CHIROPRACTIC CENTER,P.L.L.C.
Entity Type:Organization
Organization Name:DELTA CHIROPRACTIC CENTER,P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:ZIA
Authorized Official - Last Name:KHORRAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-681-4107
Mailing Address - Street 1:222 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-1523
Mailing Address - Country:US
Mailing Address - Phone:989-681-4107
Mailing Address - Fax:989-681-3628
Practice Address - Street 1:222 N MILL ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1523
Practice Address - Country:US
Practice Address - Phone:989-681-4107
Practice Address - Fax:989-681-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI144967141Medicaid
MI950B950020OtherBCBS PIN#
MI950B950020OtherBCBS PIN#
MIU93646Medicare UPIN