Individual
DR. JEFFREY EDWARD FANTICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
5829 W MAPLE RD, SUITE 123, WEST BLOOMFIELD, MI 48322-2294
(248) 737-8066
(248) 737-9093
Mailing address
5829 W MAPLE RD, SUITE 123, WEST BLOOMFIELD, MI 48322-2294
(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
BC PIN
MI
01
—
461982008
TAX ID
MI
Enumeration date
02/07/2007
Last updated
02/26/2013
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