Provider Demographics
NPI:1346407764
Name:DIMITRIOU CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:DIMITRIOU CHIROPRACTIC CENTER LLC
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:DIMITRIOU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-471-7188
Mailing Address - Street 1:38431 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1517
Mailing Address - Country:US
Mailing Address - Phone:248-471-7188
Mailing Address - Fax:
Practice Address - Street 1:38431 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-1517
Practice Address - Country:US
Practice Address - Phone:248-471-7188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4544397Medicaid
MI950F334140Medicare UPIN
MIOF35304Medicare PIN