Healthcare Provider Details

I. General information

NPI: 1376868083
Provider Name (Legal Business Name): GREAT LAKES CHIROPRACTIC ORTHOPEDICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E CHICAGO RD
COLDWATER MI
49036-8130
US

IV. Provider business mailing address

601 E CHICAGO RD
COLDWATER MI
49036-8130
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-7246
  • Fax: 517-279-2858
Mailing address:
  • Phone: 517-278-7246
  • Fax: 517-279-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberSG007175
License Number StateMI

VIII. Authorized Official

Name: DR. SEAN P GROVES
Title or Position: OWNER
Credential: DC
Phone: 517-278-7246