Healthcare Provider Details

I. General information

NPI: 1114989423
Provider Name (Legal Business Name): CHIRO-TECHNOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 DELHI COMMERCE DR SUITE 1A
HOLT MI
48842-2192
US

IV. Provider business mailing address

2385 DELHI COMMERCE DR SUITE 1A
HOLT MI
48842-2192
US

V. Phone/Fax

Practice location:
  • Phone: 517-694-4972
  • Fax: 517-694-5898
Mailing address:
  • Phone: 517-694-4972
  • Fax: 517-694-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KATHRYN ANN KITTLE
Title or Position: FINANCIAL SUPERVISOR
Credential:
Phone: 517-694-4972