Healthcare Provider Details

I. General information

NPI: 1063697084
Provider Name (Legal Business Name): AUSABLE CHIROPRACTIC CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S DEYARMOND ST
MIO MI
48647-9108
US

IV. Provider business mailing address

PO BOX 426
MIO MI
48647-0426
US

V. Phone/Fax

Practice location:
  • Phone: 989-329-9733
  • Fax:
Mailing address:
  • Phone: 989-826-3333
  • Fax: 989-826-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009407
License Number StateMI

VIII. Authorized Official

Name: DR. KIMBERLY S HUNTER
Title or Position: OWNER/MEMBER
Credential: D.C.
Phone: 989-826-3333