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General NPI Number Information
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NPI Number | 1801270202
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIRO NILES
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 60 E MAIN ST
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City | NILES
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State | MI
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Zip | 49120-2284
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Country | US
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Telephone | 269-683-5433
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Fax | 269-262-4337
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Provider Business Mailing Address
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Address Line | 60 E MAIN ST PO BOX 256
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City | NILES
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State | MI
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Zip | 49120-2284
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Country | US
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Telephone | 269-683-5433
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Fax | 269-262-4337
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIMBERLY R STOWE
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Credential |
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Telephone | 269-683-5433
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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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