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NPI Code Detail

MEDICARE: THIRD COAST CHIROPRACTIC LLC

MEDICARE: THIRD COAST CHIROPRACTIC LLC
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
1111N00000XChiropractor

General Provider Information

NPI Number : 1083100457
Entity Type Code : Organization
Provider Name (Legal Business Name) : THIRD COAST CHIROPRACTIC LLC
Provider Business Mailing Address
First Line : 1201 E FRONT ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2928
Country : US
Telephone Number : 231-354-2600
Fax Number :
Provider Business Practice Location Address
First Line : 1201 E FRONT ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2928
Country : US
Telephone Number : 231-354-2600
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. BRADLEY HAHN
Credential : DC
Telephone Number : 231-354-2600
Provider Enumeration Date : 07/09/2018
Last Update Date : 07/09/2018

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Directions to “THIRD COAST CHIROPRACTIC LLC ” Practice Location

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