Healthcare Provider Details

I. General information

NPI: 1194788521
Provider Name (Legal Business Name): SPARTAN FAMILY CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 W GRAND RIVER AVE
OKEMOS MI
48864-1803
US

IV. Provider business mailing address

1719 W GRAND RIVER AVE
OKEMOS MI
48864-1803
US

V. Phone/Fax

Practice location:
  • Phone: 517-381-9730
  • Fax: 517-381-9735
Mailing address:
  • Phone: 517-381-9730
  • Fax: 517-381-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2301008073
License Number StateMI

VIII. Authorized Official

Name: KEVIN T PARKER
Title or Position: OWNER/PHYSICAN
Credential: DC
Phone: 517-381-9730