Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 7501008711 | MI |
NPI | 1245786029 |
---|---|
Provider Name | Elissa Karstu |
First Address | Detroit, MI 48226-1326 |
Second Address | Detroit, MI 48243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |