Caudell Chiropractic Clinic
Organization Active NPI Chiropractor · Dearborn Heights, MI
NPI 1740347103 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1740347103
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2301005226 (MI)
- Legal business name
- CAUDELL CHIROPRACTIC CLINIC
- Practice address
- 5928 N Telegraph Rd
Dearborn Heights, MI 48127-3221 - Phone
- (313) 563-0530
- Fax
- (313) 563-1430
- NPI assigned
- Jan 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Glenn A Caudell, DC
- Title
- Owner
- Phone
- (313) 563-0530
Practitioners 2
-
Glenn A Caudell, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111203000043 | MI | Part B Supplier - Clinic/Group Practice | 8729253794 |
Receives reassigned benefits from 2 practitioners Practice locations: Dearborn Heights, MI |
National Provider Directory
Locations
5928 N Telegraph Rd
Dearborn Hts, MI 48127
Phone (313) 563-0530
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2301005226 | MI | Yes |
Addresses
Primary practice location
5928 N Telegraph Rd
Dearborn Heights, MI 48127-3221
Mailing address
5928 N Telegraph Rd
Dearborn Heights, MI 48127-3221
Phone (313) 563-0530
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 950H25164 | Other | MI | BC |
Other providers in Dearborn Heights, MI
- Carevan Transportation LLC
- Marsha Carr
- Shantae Carter
- Elizabeth Anne Cary
- Cathedral Community Medical Clinic PC
- Glenn A Caudell
- Hussein Chahin
- Hassan Ali Chahrour
- Ali Chammout
- Hayat Chammout
All providers in Dearborn Heights, MI · Chiropractor in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.