Healthcare Provider Details

I. General information

NPI: 1659582344
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PYLE DR
KINGSFORD MI
49802-4454
US

IV. Provider business mailing address

815 PYLE DR
KINGSFORD MI
49802-4454
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-4911
  • Fax: 906-776-1778
Mailing address:
  • Phone: 906-774-4911
  • Fax: 906-776-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BETTY JANE NORR
Title or Position: OFFICE MANAGER
Credential:
Phone: 906-774-4911