Basic Information
| Provider Information | |||||||||
| NPI: | 1699079285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOVI SPINAL CARE INSTITUTE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39915 GRAND RIVER AVE | ||||||||
| Address2: | SUITE 750 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483752153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484767775 | ||||||||
| FaxNumber: | 2489874972 | ||||||||
| Practice Location | |||||||||
| Address1: | 39915 GRAND RIVER AVE | ||||||||
| Address2: | SUITE 750 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483752153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484767775 | ||||||||
| FaxNumber: | 2489874972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2010 | ||||||||
| LastUpdateDate: | 12/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | STANELY | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
| AuthorizedOfficialMiddleName: | LELAND | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 2484767775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | SS008515 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.