Individual
CHARLES CLAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
19159 MERRIMAN RD, LIVONIA, MI 48152
(248) 477-4408
Mailing address
44284 ARLINGTON RD, CANTON, MI 48187-2144
(734) 883-4874
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501010100
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7501010100
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
06/02/2017
Last updated
03/04/2019
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