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General NPI Number Information
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NPI Number | 1598810202
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Entity Type | Organization
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Legal Business Name | CHEBOYGAN CHIROPRACTIC CLINIC INC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 230 BACKUS ST
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City | CHEBOYGAN
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State | MI
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Zip | 49721-1504
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Country | US
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Telephone | 231-627-6161
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Fax | 231-627-2921
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Provider Business Mailing Address
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Address Line | 230 BACKUS ST
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City | CHEBOYGAN
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State | MI
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Zip | 49721-1504
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Country | US
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Telephone | 231-627-6161
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Fax | 231-627-2921
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUCILE M STROM BAVERS
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Credential | DC
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Telephone | 231-627-6161
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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 | LS007551
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License Number State | MI
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