1255445540 NPI number — TANNENBAUM CHIROPRACTIC LLC

Table of content: (NPI 1255445540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255445540 NPI number — TANNENBAUM CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TANNENBAUM 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:
1255445540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4059 STONE SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-929-0444
Provider Business Mailing Address Fax Number:
734-929-0350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4059 STONE SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-929-0444
Provider Business Practice Location Address Fax Number:
734-929-0350
Provider Enumeration Date:
08/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TANNENBAUM
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
OWNER CHIROPRACTOR
Authorized Official Telephone Number:
734-929-0444

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301008615 , 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: OH11212 . This is a "BLUECARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 141980 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4755140 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95OH112120 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: NC011916 . This is a "MCARE" identifier . This identifiers is of the category "OTHER".