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General NPI Number Information
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NPI Number | 1629603279
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Entity Type | Organization
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Legal Business Name | NORTHERN STAR CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 224 NEWBERRY AVE
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City | NEWBERRY
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State | MI
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Zip | 49868-1103
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Country | US
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Telephone | 906-291-2300
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Fax | 906-291-2300
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Provider Business Mailing Address
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Address Line | PO BOX 395
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City | NEWBERRY
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State | MI
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Zip | 49868-0395
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Country | US
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Telephone | 906-291-2300
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Fax | 906-291-2300
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BRIAN SCOTT STOYNOFF
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Credential | D.C.
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Telephone | 906-291-2300
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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 |
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License Number State |
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