MEDICARE: FAMILY CHIROPRACTIC HEALTHCARE CENTER, PLLC

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	2301009813	MI
2	111N00000X	Chiropractor	2301005052	MI

General Provider Information

NPI Number	:	1598003717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CHIROPRACTIC HEALTHCARE CENTER, PLLC

Provider Business Mailing Address
First Line	:	4612 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1229
Country	:	US
Telephone Number	:	616-363-7713
Fax Number	:	616-363-4958

Authorized Official
Title or Position	:	PROVIDER
Name	:	DR. DANIEL GERARD VANGESSEL
Credential	:	D.C.
Telephone Number	:	616-363-7713

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	01/23/2013

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