MEDICARE: FAMILY FIRST CHIROPRACTIC PC

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

General Provider Information

NPI Number	:	1154384949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	8618 GRAINERY RD SE
Second Line	:
City	:	CALEDONIA
State	:	MI
Zip	:	49316-8129
Country	:	US
Telephone Number	:	616-275-1234
Fax Number	:	616-275-1140

Provider Business Practice Location Address
First Line	:	10011 CROSSROAD CT SE
Second Line	:
City	:	CALEDONIA
State	:	MI
Zip	:	49316-7578
Country	:	US
Telephone Number	:	616-275-1234
Fax Number	:	616-275-1140

Authorized Official
Title or Position	:	ACCESS MANAGER
Name	:	MRS. SHAYA DANIELE NEWQUIST
Credential	:
Telephone Number	:	616-275-1234

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/13/2021

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