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NPI Code Detail

MEDICARE: CHERRYLAND CHIROPRACTIC CENTRE PC

MEDICARE: CHERRYLAND CHIROPRACTIC CENTRE 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
1111N00000XChiropractor2301004541MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10B811650OTHERMIBLUE CROSS
20B812230OTHERBLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639281330
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHERRYLAND CHIROPRACTIC CENTRE PC
Provider Business Mailing Address
First Line : 1209 E 8TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2938
Country : US
Telephone Number : 231-941-8650
Fax Number : 231-941-8652
Provider Business Practice Location Address
First Line : 1209 E 8TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-2938
Country : US
Telephone Number : 231-941-8650
Fax Number : 231-941-8652
Authorized Official
Title or Position : CHIROPRACTOR
Name : MR. EDWARD JOHN SEKOL
Credential : DC
Telephone Number : 231-941-8650
Provider Enumeration Date : 08/31/2006
Last Update Date : 03/05/2008

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Directions to “CHERRYLAND CHIROPRACTIC CENTRE PC ” Practice Location

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