Healthcare Provider Details

I. General information

NPI: 1386151793
Provider Name (Legal Business Name): BJS CHIROPRACTIC, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N STONE RD
FREMONT MI
49412-0435
US

IV. Provider business mailing address

6098 E 124TH
SAND LAKE MI
49343-9628
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-2590
  • Fax: 231-924-6560
Mailing address:
  • Phone: 231-225-8704
  • Fax: 231-924-6560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009031
License Number StateMI

VIII. Authorized Official

Name: DR. BROCK JASON SEMLOW
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 231-225-8704