Provider Demographics
NPI:1043524366
Name:GRAND RAPIDS FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:GRAND RAPIDS FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:EMMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-975-1100
Mailing Address - Street 1:6771 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6849
Mailing Address - Country:US
Mailing Address - Phone:616-975-1100
Mailing Address - Fax:616-975-1121
Practice Address - Street 1:6771 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6849
Practice Address - Country:US
Practice Address - Phone:616-975-1100
Practice Address - Fax:616-975-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty