MEDICARE: MITTEN 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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1902648124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITTEN CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	3315 BADGER AVE SW
Second Line	:
City	:	WYOMING
State	:	MI
Zip	:	49509-3052
Country	:	US
Telephone Number	:	616-206-6428
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 W MAIN ST
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-1639
Country	:	US
Telephone Number	:	616-206-6428
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THY NGUYEN
Credential	:	DC
Telephone Number	:	616-206-6428

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	08/13/2024

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Directions to “MITTEN CHIROPRACTIC, LLC ” Practice Location

Language	Start Address	Practice Location

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