Healthcare Provider Details

I. General information

NPI: 1003972134
Provider Name (Legal Business Name): MARSHALL CHIROPRACTIC LIFE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E MICHIGAN AVE
MARSHALL MI
49068-1667
US

IV. Provider business mailing address

420 E MICHIGAN AVE
MARSHALL MI
49068-1667
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-7000
  • Fax: 269-781-2522
Mailing address:
  • Phone: 269-781-7000
  • Fax: 269-781-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4380
License Number StateMI

VIII. Authorized Official

Name: DR. PHILIP L KNIGHT
Title or Position: PRESIDENT
Credential: D.C.
Phone: 269-781-7000