Healthcare Provider Details

I. General information

NPI: 1215369335
Provider Name (Legal Business Name): 14TH STREET CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 14TH ST.
TRAVERSE CITY MI
49684
US

IV. Provider business mailing address

115 E 14TH ST
TRAVERSE CITY MI
49684-3220
US

V. Phone/Fax

Practice location:
  • Phone: 231-943-1767
  • Fax:
Mailing address:
  • Phone: 231-943-1767
  • Fax: 231-943-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005659
License Number StateMI

VIII. Authorized Official

Name: NATHAN ALLAN REED
Title or Position: OWNER
Credential:
Phone: 231-943-1767