Organization
JEFFREY E. FANTICH, DC, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY EDWARD FANTICH D.C. (OWNER)
(248) 737-8066
Entity
Organization
Contact information
Practice address
6022 W MAPLE RD, SUITE 405, WEST BLOOMFIELD, MI 48322-4408
(248) 737-8066
(248) 737-9093
Mailing address
6022 W MAPLE RD, SUITE 405, WEST BLOOMFIELD, MI 48322-4408
(248) 737-8066
(248) 737-9093
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301006930
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F35177
BLUE CROSS
MI
Enumeration date
04/24/2008
Last updated
04/24/2012
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