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General NPI Number Information
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NPI Number | 1386151793
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Entity Type | Organization
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Legal Business Name | BJS CHIROPRACTIC, PLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 119 N STONE RD
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City | FREMONT
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State | MI
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Zip | 49412-0435
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Country | US
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Telephone | 231-924-2590
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Fax | 231-924-6560
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Provider Business Mailing Address
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Address Line | 6098 E 124TH
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City | SAND LAKE
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State | MI
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Zip | 49343-9628
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Country | US
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Telephone | 231-225-8704
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Fax | 231-924-6560
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. BROCK JASON SEMLOW
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Credential | DC
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Telephone | 231-225-8704
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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 | 2301009031
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License Number State | MI
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