Provider Demographics
NPI:1154585404
Name:SHORES CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:SHORES CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIGLIAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-775-6500
Mailing Address - Street 1:28404 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1607
Mailing Address - Country:US
Mailing Address - Phone:586-775-6500
Mailing Address - Fax:586-775-6591
Practice Address - Street 1:28404 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1607
Practice Address - Country:US
Practice Address - Phone:586-775-6500
Practice Address - Fax:586-775-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366529422OtherTYPE 1 NPI BCBSM
MI3267532Medicaid
MIU61364Medicare UPIN
MI3267532Medicaid