Provider Demographics
NPI:1811903313
Name:SILVERBACK, INC.
Entity type:Organization
Organization Name:SILVERBACK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANADI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-437-7991
Mailing Address - Street 1:9851 ATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9111
Mailing Address - Country:US
Mailing Address - Phone:248-437-7355
Mailing Address - Fax:
Practice Address - Street 1:12516 TEN MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8171
Practice Address - Country:US
Practice Address - Phone:248-437-7991
Practice Address - Fax:248-437-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95 0F377450OtherBLUE CROSS BLUE SHIELD
MI0P34670Medicare PIN