MEDICARE: LEELANAU FAMILY CHIROPRACTIC INC

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	2301004944	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0D55002	OTHER	MI	MEDICARE IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1821231200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEELANAU FAMILY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	PO BOX 224
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653-0224
Country	:	US
Telephone Number	:	231-256-2500
Fax Number	:	231-256-2575

Provider Business Practice Location Address
First Line	:	208 W MAIN ST
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653-5104
Country	:	US
Telephone Number	:	231-256-2500
Fax Number	:	231-256-2575

Authorized Official
Title or Position	:	OWNER
Name	:	MARIE GENNA PARENT
Credential	:	D.C.
Telephone Number	:	231-256-2500

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/14/2009

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Directions to “LEELANAU FAMILY CHIROPRACTIC INC ” Practice Location

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