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General NPI Number Information
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NPI Number | 1194788521
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Entity Type | Organization
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Legal Business Name | SPARTAN FAMILY CHIROPRACTIC, INC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 1719 W GRAND RIVER AVE
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City | OKEMOS
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State | MI
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Zip | 48864-1803
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Country | US
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Telephone | 517-381-9730
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Fax | 517-381-9735
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Provider Business Mailing Address
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Address Line | 1719 W GRAND RIVER AVE
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City | OKEMOS
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State | MI
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Zip | 48864-1803
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Country | US
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Telephone | 517-381-9730
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Fax | 517-381-9735
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Authorized Official
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Title or Position | OWNER/PHYSICAN
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Name | KEVIN T PARKER
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Credential | DC
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Telephone | 517-381-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2301008073
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License Number State | MI
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