Healthcare Provider Details

I. General information

NPI: 1124032040
Provider Name (Legal Business Name): EDMORE CHIROPRACTIC CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W HOWARD CITY EDMORE RD
EDMORE MI
48829-9779
US

IV. Provider business mailing address

215 W HOWARD CITY EDMORE RD
EDMORE MI
48829-9779
US

V. Phone/Fax

Practice location:
  • Phone: 989-427-5551
  • Fax: 989-427-3102
Mailing address:
  • Phone: 989-427-5551
  • Fax: 989-427-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301006849
License Number StateMI

VIII. Authorized Official

Name: DR. JEFFREY KENNETH LEE
Title or Position: OWNER/OPERATOR
Credential: D.C.
Phone: 989-427-5551