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General NPI Number Information
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NPI Number | 1104327493
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Entity Type | Organization
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Legal Business Name | MACK CHIROPRACTIC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 2901 W MICHIGAN AVE
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City | JACKSON
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State | MI
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Zip | 49202-1805
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Country | US
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Telephone | 517-748-7799
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Fax | 833-300-9391
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Provider Business Mailing Address
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Address Line | 5160 RIVES JUNCTION RD
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City | JACKSON
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State | MI
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Zip | 49201-9453
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Country | US
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Telephone | 517-990-4163
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. JOSHUA KIRK MACK
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Credential | DC
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Telephone | 517-748-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301010285
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License Number State | MI
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