Healthcare Provider Details

I. General information

NPI: 1235384041
Provider Name (Legal Business Name): CLEAR CHOICE CHIROPRACTIC OF EDWARDSBURG, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69821 M 62 STE 12
EDWARDSBURG MI
49112-8807
US

IV. Provider business mailing address

69821 M 62 STE 12
EDWARDSBURG MI
49112-8807
US

V. Phone/Fax

Practice location:
  • Phone: 269-663-6600
  • Fax: 269-663-6609
Mailing address:
  • Phone: 269-663-6600
  • Fax: 269-663-6609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501001411
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007476
License Number StateMI

VIII. Authorized Official

Name: DR. TOBY ANDREW MITCHELL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 269-663-6600