Provider Demographics
NPI:1588980775
Name:TAGAI FAMILY CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:TAGAI FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:TAGAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-867-2377
Mailing Address - Street 1:29510 FOUNTAIN BLVD
Mailing Address - Street 2:# 1102
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5809
Mailing Address - Country:US
Mailing Address - Phone:248-867-2377
Mailing Address - Fax:
Practice Address - Street 1:3355 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4551
Practice Address - Country:US
Practice Address - Phone:248-867-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty