Provider Demographics
NPI:1699079285
Name:NOVI SPINAL CARE INSTITUTE LLC
Entity type:Organization
Organization Name:NOVI SPINAL CARE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:LELAND
Authorized Official - Last Name:STANELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-476-7775
Mailing Address - Street 1:39915 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2153
Mailing Address - Country:US
Mailing Address - Phone:248-476-7775
Mailing Address - Fax:248-987-4972
Practice Address - Street 1:39915 GRAND RIVER AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2153
Practice Address - Country:US
Practice Address - Phone:248-476-7775
Practice Address - Fax:248-987-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS008515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty