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General NPI Number Information
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NPI Number | 1174711105
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Entity Type | Organization
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Legal Business Name | BORCK FAMILY CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 227 W MAIN ST
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City | HUDSON
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State | MI
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Zip | 49247-1001
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Country | US
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Telephone | 517-448-2277
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Fax | 517-448-2288
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Provider Business Mailing Address
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Address Line | PO BOX 47
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City | HUDSON
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State | MI
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Zip | 49247-0047
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Country | US
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Telephone | 517-448-2277
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Fax | 517-448-2288
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COREY JASON BORCK
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Credential | D.C.
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Telephone | 517-448-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 2301008759
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License Number State | MI
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