1770794315 NPI number — PARAGON CHIROPRACTIC AND WELLNESS CENTER PLLC

Table of content: (NPI 1770794315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770794315 NPI number — PARAGON CHIROPRACTIC AND WELLNESS CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGON CHIROPRACTIC AND WELLNESS CENTER PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770794315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6405 TELEGRAPH RD
Provider Second Line Business Mailing Address:
H - 3
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48301-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-590-2195
Provider Business Mailing Address Fax Number:
248-590-2198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
H - 3
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48301-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-590-2195
Provider Business Practice Location Address Fax Number:
248-590-2198
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCALEER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER / CHIROPRACTOR
Authorized Official Telephone Number:
248-590-2195

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301008396 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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