Provider Demographics
NPI:1194414003
Name:MULARSKI, THERESA (LMT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MULARSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RENAISSANCE CHIROPRACTIC
Mailing Address - Street 2:4001 WALLI STRASSE DR
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1731
Mailing Address - Country:US
Mailing Address - Phone:810-715-7746
Mailing Address - Fax:810-715-7716
Practice Address - Street 1:RENAISSANCE CHIROPRACTIC
Practice Address - Street 2:4001 WALLI STRASSE DR
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1731
Practice Address - Country:US
Practice Address - Phone:810-715-7746
Practice Address - Fax:810-715-7716
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007518225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist