Provider Demographics
NPI:1285247668
Name:FOREVER OAK HEALTH CENTER, PLC.
Entity type:Organization
Organization Name:FOREVER OAK HEALTH CENTER, PLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-284-0782
Mailing Address - Street 1:2520 S TELEGRAPH RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0203
Mailing Address - Country:US
Mailing Address - Phone:248-907-0887
Mailing Address - Fax:248-907-0886
Practice Address - Street 1:2520 S TELEGRAPH RD STE 107
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0203
Practice Address - Country:US
Practice Address - Phone:248-907-0887
Practice Address - Fax:248-907-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty