Provider Demographics
NPI:1316000391
Name:DIVERSE HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:DIVERSE HEALTH SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:TENT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-477-0380
Mailing Address - Street 1:39595 W 10 MILE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2948
Mailing Address - Country:US
Mailing Address - Phone:248-477-0380
Mailing Address - Fax:248-477-8320
Practice Address - Street 1:39595 W 10 MILE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2948
Practice Address - Country:US
Practice Address - Phone:248-477-0380
Practice Address - Fax:248-477-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty