Provider Demographics
NPI:1043751290
Name:SQUIRES FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:SQUIRES FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-690-5034
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:SCOTTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49454-0296
Mailing Address - Country:US
Mailing Address - Phone:231-757-3356
Mailing Address - Fax:231-757-4640
Practice Address - Street 1:414 W US HIGHWAY 10 31
Practice Address - Street 2:
Practice Address - City:SCOTTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49454-9274
Practice Address - Country:US
Practice Address - Phone:231-757-3356
Practice Address - Fax:231-757-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010504261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111N00000XMedicaid
MI111N00000XMedicare UPIN
MI111N00000XMedicaid
MI111N00000XMedicare PIN