Healthcare Provider Details

I. General information

NPI: 1164894648
Provider Name (Legal Business Name): NORTHERN LIGHTS CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 CROSSING CIR SUITE A
TRAVERSE CITY MI
49684-7955
US

IV. Provider business mailing address

2506 CROSSING CIR SUITE A
TRAVERSE CITY MI
49684-7955
US

V. Phone/Fax

Practice location:
  • Phone: 231-421-3333
  • Fax: 231-421-3355
Mailing address:
  • Phone: 231-421-3333
  • Fax: 231-421-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010350
License Number StateMI

VIII. Authorized Official

Name: RAMONA PLEVA
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 231-510-8682