Provider Demographics
NPI:1780132845
Name:MICHIGAN CHIROPRACTIC AND MEDICAL MASSAGE CLINIC, LLC
Entity type:Organization
Organization Name:MICHIGAN CHIROPRACTIC AND MEDICAL MASSAGE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-309-1286
Mailing Address - Street 1:23300 GREENFIELD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-8407
Mailing Address - Country:US
Mailing Address - Phone:786-309-1286
Mailing Address - Fax:
Practice Address - Street 1:23300 GREENFIELD RD STE 104
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-8407
Practice Address - Country:US
Practice Address - Phone:786-309-1286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty