Healthcare Provider Details

I. General information

NPI: 1881854164
Provider Name (Legal Business Name): SPECIALIZED FAMILY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 MOORSBRIDGE RD SUITE B
PORTAGE MI
49024
US

IV. Provider business mailing address

8150 MOORSBRIDGE RD SUITE B
PORTAGE MI
49024
US

V. Phone/Fax

Practice location:
  • Phone: 269-323-4473
  • Fax: 269-324-0755
Mailing address:
  • Phone: 269-324-4143
  • Fax: 269-324-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: STEVEN T OSTERHOUT
Title or Position: OWNER
Credential: DC
Phone: 269-324-4143