1538429931 NPI number — CARROLL CHIROPRACTIC, INC

Table of content: (NPI 1538429931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538429931 NPI number — CARROLL CHIROPRACTIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARROLL CHIROPRACTIC, 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:
1538429931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8965 BURT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRCH RUN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48415-8794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-624-9293
Provider Business Mailing Address Fax Number:
989-624-9294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11945 CONQUEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRCH RUN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48415-9294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-624-9293
Provider Business Practice Location Address Fax Number:
989-624-9294
Provider Enumeration Date:
05/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
989-624-9293

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  AC009035 , 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: 5179180 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com