Provider Demographics
NPI:1982716676
Name:DETROIT INJURY AND PAIN CENTERS , PLLC
Entity Type:Organization
Organization Name:DETROIT INJURY AND PAIN CENTERS , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMERIUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-579-3472
Mailing Address - Street 1:7200 GRATIOT AVE
Mailing Address - Street 2:DETROIT INJURY AND PAIN CENTERS, PLLC
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-2816
Mailing Address - Country:US
Mailing Address - Phone:313-579-3472
Mailing Address - Fax:313-579-1388
Practice Address - Street 1:7220 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-2816
Practice Address - Country:US
Practice Address - Phone:313-579-3472
Practice Address - Fax:313-579-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007399111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty