Organization
GRAND RIVER PHYSICAL MEDICINE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE STANLEY (OWNER)
(248) 476-7775
Entity
Organization
Contact information
Practice address
39915 GRAND RIVER AVE, SUITE # 750, NOVI, MI 48375-2153
(248) 476-7775
(248) 987-4972
Mailing address
39915 GRAND RIVER AVE, SUITE # 750, NOVI, MI 48375-2153
(248) 476-7775
(248) 987-4972
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
SS008515
MI
2083X0100X
Occupational Medicine Physician
Primary
5101008610
MI
363LA2200X
Adult Health Nurse Practitioner
4704268297
MI
Other
Enumeration date
04/24/2013
Last updated
06/17/2013
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