MEDICARE: PICHE FAMILY 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	2301007905	MI

General Provider Information

NPI Number	:	1598840274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PICHE FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1832 OAK HOLLOW DR
Second Line	:	B
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-5918
Country	:	US
Telephone Number	:	231-995-0990
Fax Number	:	231-995-0991

Provider Business Practice Location Address
First Line	:	1832 OAK HOLLOW DR
Second Line	:	B
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-5918
Country	:	US
Telephone Number	:	231-995-0990
Fax Number	:	231-995-0991

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH PATRICK PICHE
Credential	:	D.C.
Telephone Number	:	231-995-0990

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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