MEDICARE: NORTHCARE CHIROPRACTIC HEALTH CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301007022	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	950B810180	OTHER	MI	BCBS GROUP PROVIDER ID
3	G05544	OTHER	MI	BCN GROUP #

General Provider Information

NPI Number	:	1073512786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHCARE CHIROPRACTIC HEALTH CENTER, PLLC

Provider Business Mailing Address
First Line	:	2781 GARFIELD RD N
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-5003
Country	:	US
Telephone Number	:	231-933-0100
Fax Number	:	231-946-1951

Provider Business Practice Location Address
First Line	:	2781 GARFIELD RD N
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-5003
Country	:	US
Telephone Number	:	231-933-0100
Fax Number	:	231-946-1951

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TERI LORENCEN STOCKWELL
Credential	:	D.C.
Telephone Number	:	231-933-0100

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	10/07/2010

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