=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891395364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLEN FAMILY CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2020
-----------------------------------------------------
Last Update Date | 10/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 W MICHIGAN AVE
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49236-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-456-7411
-----------------------------------------------------
Fax | 517-456-7896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 616
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49236-0616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-456-7411
-----------------------------------------------------
Fax | 517-456-7896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KAREN ELIZABETH HOLEN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 517-456-7411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------