Healthcare Provider Details
I. General information
NPI: 1215280862
Provider Name (Legal Business Name): SAUGATUCK CHIROPRACTIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/19/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3219 BLUE STAR HWY 200
SAUGATUCK MI
49453-9786
US
IV. Provider business mailing address
3219 BLUE STAR HWY 200
SAUGATUCK MI
49453-9786
US
V. Phone/Fax
- Phone: 269-857-1900
- Fax: 269-857-1900
- Phone: 269-857-1900
- Fax: 269-857-1900
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | 2301009993 |
| License Number State | MI |
VIII. Authorized Official
Name: DR.
CURTIS
DUANE
DAY
Title or Position: OWNER/DIRECTOR
Credential: D.C.
Phone: 269-857-1900