Provider Demographics
NPI:1912249475
Name:BROOKLYN ENTERPRISES LLC
Entity Type:Organization
Organization Name:BROOKLYN ENTERPRISES LLC
Other - Org Name:ADVANCED STRUCTURAL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SINGLE MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYTHEM
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-949-6206
Mailing Address - Street 1:42040 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1831
Mailing Address - Country:US
Mailing Address - Phone:248-387-2788
Mailing Address - Fax:248-679-3061
Practice Address - Street 1:42040 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1831
Practice Address - Country:US
Practice Address - Phone:248-387-2788
Practice Address - Fax:248-679-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009067111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144370578Medicaid
MI1144370578Medicaid