1669716551 NPI number — CHELSEA CHIROPRACTIC & FUNCTIONAL NEUROLOGY LLC

Table of content: (NPI 1669716551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669716551 NPI number — CHELSEA CHIROPRACTIC & FUNCTIONAL NEUROLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHELSEA CHIROPRACTIC & FUNCTIONAL NEUROLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1669716551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20780 ISLAND LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELSEA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48118-9584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 W MIDDLE ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48118-1293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-845-1080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KEISER
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
DIRECTOR OF FUNCTIONAL NEUROLOGY
Authorized Official Telephone Number:
734-845-1080

Provider Taxonomy Codes

  • Taxonomy code: 111NN0400X , with the licence number:  2301010030 , 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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