MEDICARE: FAMILY ROOTS CHIROPRACTIC

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	:	1265199517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY ROOTS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	549 26TH ST
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-2324
Country	:	US
Telephone Number	:	906-399-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 S 11TH ST
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-1504
Country	:	US
Telephone Number	:	906-399-5636
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAYLOR MILLER
Credential	:	DC
Telephone Number	:	906-399-5636

Provider Enumeration Date	:	11/22/2021
Last Update Date	:	11/22/2021

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Directions to “FAMILY ROOTS CHIROPRACTIC ” Practice Location

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