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General NPI Number Information
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NPI Number | 1336512235
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Entity Type | Organization
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Legal Business Name | PROLIFIC FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 809 W GANSON ST
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City | JACKSON
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State | MI
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Zip | 49202-4202
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Country | US
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Telephone | 517-990-8858
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Fax | 517-990-8850
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Provider Business Mailing Address
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Address Line | 809 W GANSON ST
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City | JACKSON
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State | MI
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Zip | 49202-4202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. BRANDON COOLEY
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Credential |
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Telephone | 517-990-8858
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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 | 2301010182
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License Number State | MI
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