NPIMap

Organization Active NPI

Advanced Chiropractic

  • Rehabilitation Chiropractor
  • Detroit, MI
National Provider Identifier
1104245653
Registry record updated Apr 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
2301007342 Issued in MI
Legal business name
ADVANCED CHIROPRACTIC
Practice address
17600 W Warren Ave
Detroit, MI 48228-3509
Phone
(313) 420-9655
NPI assigned
Apr 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Reza Hafezi, D.C.
Title
Chiropractic
Phone
(313) 420-9655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NR0400X 2301007342 MI Primary

Addresses

Primary practice location

17600 W Warren Ave
Detroit, MI 48228-3509

Mailing address

17600 W Warren Ave
Detroit, MI 48228-3509
Phone (313) 420-9655

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397433600000",
    "number": "1104245653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17600 W WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482283509",
            "telephone_number": "313-420-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17600 W WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482283509",
            "telephone_number": "313-420-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-14",
        "last_updated": "2014-04-14",
        "status": "A",
        "authorized_official_last_name": "HAFEZI",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "CHIROPRACTIC",
        "authorized_official_telephone_number": "313-420-9655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "MI",
            "license": "2301007342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.