Provider Demographics
NPI:1255702346
Name:MICHAEL SOLOMON CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:MICHAEL SOLOMON CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-300-8806
Mailing Address - Street 1:4154 S RIVER RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-2930
Mailing Address - Country:US
Mailing Address - Phone:810-300-8806
Mailing Address - Fax:810-329-3058
Practice Address - Street 1:4154 S RIVER RD BLDG 2
Practice Address - Street 2:
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-2930
Practice Address - Country:US
Practice Address - Phone:810-300-8806
Practice Address - Fax:810-329-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP37940002Medicare PIN
MIV10831Medicare UPIN