Provider Demographics
NPI:1003972134
Name:MARSHALL CHIROPRACTIC LIFE CENTER, P.C.
Entity Type:Organization
Organization Name:MARSHALL CHIROPRACTIC LIFE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-781-7000
Mailing Address - Street 1:420 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1667
Mailing Address - Country:US
Mailing Address - Phone:269-781-7000
Mailing Address - Fax:269-781-2522
Practice Address - Street 1:420 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1667
Practice Address - Country:US
Practice Address - Phone:269-781-7000
Practice Address - Fax:269-781-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG02572OtherBLUE CARE NETWORK GROUP #
MI1387380Medicaid
MI0N98660Medicare ID - Type UnspecifiedMEDICARE GROUP ID
MIT98784Medicare UPIN