Provider Demographics
NPI:1285292045
Name:PROGRESSIVE CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:PROGRESSIVE CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRGICAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-544-9009
Mailing Address - Street 1:716 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2411
Mailing Address - Country:US
Mailing Address - Phone:248-544-9009
Mailing Address - Fax:
Practice Address - Street 1:716 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2411
Practice Address - Country:US
Practice Address - Phone:248-544-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty