=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295445799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT LAKES CHIROPRACTIC PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2022
-----------------------------------------------------
Last Update Date | 05/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5136 CASCADE RD SE STE 1D
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-3728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-310-1207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5136 CASCADE RD SE STE 1D
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-3728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 181-031-0120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHRISTOPHER SASS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 810-310-1207
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN0400X
-----------------------------------------------------
Taxonomy Name | Neurology Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------