1437215639 NPI number — COMPLETE CHIROPRACTIC CARE, INC

Table of content: (NPI 1437215639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437215639 NPI number — COMPLETE CHIROPRACTIC CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE CHIROPRACTIC CARE, INC
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:
1437215639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11225 S SAGINAW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-1285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-694-8031
Provider Business Mailing Address Fax Number:
810-736-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11225 S SAGINAW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-1285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-694-8031
Provider Business Practice Location Address Fax Number:
810-736-3122
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIDLINE
Authorized Official First Name:
CORRINA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
810-694-8031

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CF007120 , 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)

  • Identifier: P75997 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3239707 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9493455001 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G06353 . This is a "BCM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 604354 . This is a "ACN MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P106543 . This is a "BCM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 132239 . This is a "ASHN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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