Healthcare Provider Details

I. General information

NPI: 1275808180
Provider Name (Legal Business Name): JENNIFER CULP CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9751 E GRAND RIVER AVE STE 2
PORTLAND MI
48875-9774
US

IV. Provider business mailing address

9751 E GRAND RIVER AVE STE 2
PORTLAND MI
48875-9774
US

V. Phone/Fax

Practice location:
  • Phone: 517-994-6007
  • Fax: 517-994-6009
Mailing address:
  • Phone: 517-994-6007
  • Fax: 517-994-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007494
License Number StateMI

VIII. Authorized Official

Name: DR. JENNIFER M CULP
Title or Position: OWNER
Credential: D.C.
Phone: 517-994-6009