Healthcare Provider Details

I. General information

NPI: 1720117880
Provider Name (Legal Business Name): LAPEER CHIROPRACTIC CENTRE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 S MAIN ST
LAPEER MI
48446-2427
US

IV. Provider business mailing address

498 S MAIN ST
LAPEER MI
48446-2427
US

V. Phone/Fax

Practice location:
  • Phone: 810-664-5310
  • Fax: 810-664-0221
Mailing address:
  • Phone: 810-664-5310
  • Fax: 810-664-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007261
License Number StateMI

VIII. Authorized Official

Name: DR. MARK H. OCHADLEUS
Title or Position: CHIROPRATOR
Credential: DC
Phone: 810-664-5310