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General NPI Number Information
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NPI Number | 1174619464
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Entity Type | Organization
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Legal Business Name | CADILLAC CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 302 E CASS ST
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City | CADILLAC
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State | MI
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Zip | 49601-2170
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Country | US
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Telephone | 231-775-8087
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Fax | 231-775-8097
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | CADILLAC
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State | MI
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Zip | 49601-0428
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Country | US
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Telephone | 231-775-6076
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Fax | 231-775-0027
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT REAGAN
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Credential | DC
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Telephone | 231-775-8087
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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 |
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License Number State |
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