Provider Demographics
NPI:1588763627
Name:FLORES, LUIS RAMON JR (DC)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAMON
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6104
Mailing Address - Country:US
Mailing Address - Phone:734-246-5488
Mailing Address - Fax:734-246-5490
Practice Address - Street 1:1642 EUREKA RD
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6104
Practice Address - Country:US
Practice Address - Phone:734-246-5488
Practice Address - Fax:734-246-5490
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383038472OtherCOMMERCIAL
MI143028168Medicaid
MI950H252410OtherBLUE CROSS BLUE SHIELD
MI383038472OtherCOMMERCIAL
MI0H25241Medicare ID - Type Unspecified