Healthcare Provider Details

I. General information

NPI: 1174711105
Provider Name (Legal Business Name): BORCK FAMILY CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W MAIN ST
HUDSON MI
49247-1001
US

IV. Provider business mailing address

PO BOX 47
HUDSON MI
49247-0047
US

V. Phone/Fax

Practice location:
  • Phone: 517-448-2277
  • Fax: 517-448-2288
Mailing address:
  • Phone: 517-448-2277
  • Fax: 517-448-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number2301008759
License Number StateMI

VIII. Authorized Official

Name: DR. COREY JASON BORCK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 517-448-2277