Provider Demographics
NPI:1215330949
Name:PLATZ, TRISTA MARIE (DC)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:MARIE
Last Name:PLATZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16231 W 14 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3323
Mailing Address - Country:US
Mailing Address - Phone:248-480-0357
Mailing Address - Fax:248-480-0361
Practice Address - Street 1:16231 W 14 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3323
Practice Address - Country:US
Practice Address - Phone:248-480-0357
Practice Address - Fax:248-480-0361
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP09200003Medicare PIN