Organization
SHALLOW CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY JOE SHALLOW DC (PRESIDENT/DIRECTOR)
(313) 277-3766
Entity
Organization
Contact information
Practice address
24820 MICHIGAN AVE, DEARBORN, MI 48124-1713
(313) 277-3766
(313) 277-7196
Mailing address
24820 MICHIGAN AVE, DEARBORN, MI 48124-1713
(313) 277-3766
(313) 277-7196
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301004116
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RS004116
BCBS
MI
Enumeration date
08/09/2005
Last updated
08/22/2020
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