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General NPI Number Information
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NPI Number | 1639281330
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Entity Type | Organization
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Legal Business Name | CHERRYLAND CHIROPRACTIC CENTRE PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 1209 E 8TH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-2938
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Country | US
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Telephone | 231-941-8650
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Fax | 231-941-8652
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Provider Business Mailing Address
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Address Line | 1209 E 8TH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-2938
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Country | US
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Telephone | 231-941-8650
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Fax | 231-941-8652
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MR. EDWARD JOHN SEKOL
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Credential | DC
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Telephone | 231-941-8650
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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 | 2301004541
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License Number State | MI
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