Healthcare Provider Details

I. General information

NPI: 1932466398
Provider Name (Legal Business Name): CHIROPRACTIC PROFESSIONAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 PINETREE RD SUITE 101
LANSING MI
48911-4286
US

IV. Provider business mailing address

1701 LAKE LANSING RD SUITE 100
LANSING MI
48912-3798
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-0001
  • Fax:
Mailing address:
  • Phone: 517-485-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009895
License Number StateMI

VIII. Authorized Official

Name: ALISA D HOFFMAN
Title or Position: OWNER
Credential: DC
Phone: 517-485-0001