Organization
DESIRA CHIROPRACTIC LIFE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD GERARD DESIRA DC (DIRECTOR)
(734) 422-7800
Entity
Organization
Contact information
Practice address
33250 WARREN RD, WESTLAND, MI 48185-2920
(734) 422-7800
Mailing address
33250 WARREN RD, WESTLAND, MI 48185-2920
(734) 422-7800
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2301005025
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4951482
—
MI
01
—
95OH225380
BCBS MICHIGAN
MI
Enumeration date
01/16/2008
Last updated
01/16/2008
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