1174711105 NPI number — BORCK FAMILY CHIROPRACTIC P.C.

Table of content: AMBER COURTNEY BUREN LMFT (NPI 1548435340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174711105 NPI number — BORCK FAMILY CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BORCK FAMILY CHIROPRACTIC P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174711105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49247-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-448-2277
Provider Business Mailing Address Fax Number:
517-448-2288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49247-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-448-2277
Provider Business Practice Location Address Fax Number:
517-448-2288
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORCK
Authorized Official First Name:
COREY
Authorized Official Middle Name:
JASON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-448-2277

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  2301008759 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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