Organization
VIVIANI SPINAL REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY ALBERT VIVIANI DC (OWNER)
(586) 757-6814
Entity
Organization
Contact information
Practice address
25308 MOUND RD, WARREN, MI 48091-3858
(586) 757-6814
(586) 757-6816
Mailing address
25308 MOUND RD, WARREN, MI 48091-3858
(586) 757-6814
(586) 757-6816
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2301005734
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2301005734
STATE LICENSE NUMBER
MI
01
—
950EO53150
BLUE CROSS BLUE SHIELD PR
MI
Enumeration date
07/18/2007
Last updated
07/18/2007
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