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General NPI Number Information
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NPI Number | 1952845729
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Entity Type | Organization
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Legal Business Name | MISSION CHIROPRACTIC FAMILY CENTER, P.C.
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 11245 N MISSION RD
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City | CLARE
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State | MI
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Zip | 48617-9301
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Country | US
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Telephone | 989-386-5437
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Fax | 989-386-4442
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Provider Business Mailing Address
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Address Line | 11245 N MISSION RD
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City | CLARE
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State | MI
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Zip | 48617-9301
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Country | US
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Telephone | 989-386-5437
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Fax | 989-386-4442
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Authorized Official
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Title or Position | SUPERVISOR
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Name | TAMMY S BOWEN
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Credential |
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Telephone | 989-615-1988
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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 | TH009053
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License Number State | MI
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