1205972932 NPI number — MCGREGOR CHIROPRACTIC,LLC

Table of content: (NPI 1205972932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205972932 NPI number — MCGREGOR CHIROPRACTIC,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCGREGOR CHIROPRACTIC,LLC
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:
1205972932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 W HOUGHTON LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRUDENVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48651-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-366-4646
Provider Business Mailing Address Fax Number:
989-366-4647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 W HOUGHTON LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRUDENVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48651-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-366-4646
Provider Business Practice Location Address Fax Number:
989-366-4647
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCGREGOR
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-366-4646

Provider Taxonomy Codes

  • Taxonomy code: 111NI0900X , with the licence number:  DM005551 , 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: 950G210180 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com