Healthcare Provider Details

I. General information

NPI: 1295985851
Provider Name (Legal Business Name): CLEAR CHOICE CHIROPRACTIC OF NILES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E MAIN ST
NILES MI
49120-2200
US

IV. Provider business mailing address

P.O. BOX 725
NILES MI
49120-2200
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-6000
  • Fax: 269-683-6350
Mailing address:
  • Phone: 269-683-6000
  • Fax: 269-683-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007476
License Number StateMI

VIII. Authorized Official

Name: DR. TOBY ANDREW MITCHELL
Title or Position: CHAIRMAN
Credential: D.C.
Phone: 269-683-6000