MEDICARE: HUNGERFORD CHIROPRACTIC & WELLNESS CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301009688	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528314200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNGERFORD CHIROPRACTIC & WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	4172 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4527
Country	:	US
Telephone Number	:	616-419-4996
Fax Number	:	616-419-4997

Provider Business Practice Location Address
First Line	:	4172 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4527
Country	:	US
Telephone Number	:	269-377-9583
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. DANIEL WILLIAM HUNGERFORD
Credential	:	D.C.
Telephone Number	:	269-377-9583

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	11/26/2012

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