Provider Demographics
NPI:1386869121
Name:JOSEPH M LOGRASSO DC PC
Entity type:Organization
Organization Name:JOSEPH M LOGRASSO DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOGRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-777-6056
Mailing Address - Street 1:22701 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2007
Mailing Address - Country:US
Mailing Address - Phone:586-777-6056
Mailing Address - Fax:586-775-7246
Practice Address - Street 1:22701 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2007
Practice Address - Country:US
Practice Address - Phone:586-777-6056
Practice Address - Fax:586-775-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJL002224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1064890Medicaid
MI1064890Medicaid
MI0H25210Medicare ID - Type Unspecified