| Organization Name: | GRAND RIVER PHYSICAL MEDICINE PLC |
| NPI Number: | 1699119339 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANE STANLEY (OWNER) |
| Mailing Address: | 39915 Grand River Ave Suite # 750 Novi |
| State: | MI US |
| Postal Code: | 483752153 |
| Phone Number: | 2484767775 |
| Fax Number: | 2489874972 |
| NPI Enumeration Date: | 04/24/2013 |
| NPI Last Update Date: | 06/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | SS008515 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |