Organization
JACK FAILLA D.C.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK FAILLA D.C, P.C. (PRESIDENT)
(586) 772-8560
Entity
Organization
Contact information
Practice address
30045 HARPER AVE, SAINT CLAIR SHORES, MI 48082-1649
(586) 772-8560
Mailing address
30045 HARPER AVE, SAINT CLAIR SHORES, MI 48082-1649
(586) 772-8560
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301001958
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OEO5139
MEDICARE ID NUMBER
MI
Enumeration date
11/09/2009
Last updated
03/15/2010
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