Provider Demographics
NPI:1033534110
Name:STONEY CREEK CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:STONEY CREEK CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WITINKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-677-4400
Mailing Address - Street 1:6003 26 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48094-2800
Mailing Address - Country:US
Mailing Address - Phone:586-677-4400
Mailing Address - Fax:586-677-4401
Practice Address - Street 1:6003 26 MILE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094-2800
Practice Address - Country:US
Practice Address - Phone:586-677-4400
Practice Address - Fax:586-677-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOEO5232002Medicare PIN