Provider Demographics
NPI:1306142294
Name:DALE A. FLORA D.C. P. C.
Entity type:Organization
Organization Name:DALE A. FLORA D.C. P. C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLORA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-793-7791
Mailing Address - Street 1:3350 SHATTUCK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3287
Mailing Address - Country:US
Mailing Address - Phone:989-793-7791
Mailing Address - Fax:989-793-1378
Practice Address - Street 1:3350 SHATTUCK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3287
Practice Address - Country:US
Practice Address - Phone:989-793-7791
Practice Address - Fax:989-793-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301003064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G35016Medicare UPIN