Provider Demographics
NPI:1962628214
Name:RICHARD L. SEMLOW D.C, P.C
Entity type:Organization
Organization Name:RICHARD L. SEMLOW D.C, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SEMLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-455-2145
Mailing Address - Street 1:247 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1238
Mailing Address - Country:US
Mailing Address - Phone:734-455-2145
Mailing Address - Fax:734-455-2825
Practice Address - Street 1:247 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1238
Practice Address - Country:US
Practice Address - Phone:734-455-2145
Practice Address - Fax:734-455-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS007178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P16150OtherMEDICARE PLUS BLUE
MI0P16150OtherMEDICARE ADVANTAGE
MI950F328340OtherBLUE CARE NETWORK
MI950F328340OtherBCBSM
MIP16150001Medicare ID - Type UnspecifiedMEDICARE