Provider Demographics
NPI:1083814008
Name:TLCHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TLCHIROPRACTIC LLC
Other - Org Name:MEINBURG WELLNESS ADVANTAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEINBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-638-2707
Mailing Address - Street 1:701 S DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1715
Mailing Address - Country:US
Mailing Address - Phone:616-638-2707
Mailing Address - Fax:
Practice Address - Street 1:501 W FLINT ST
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1062
Practice Address - Country:US
Practice Address - Phone:810-412-8442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM008963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
07078Medicare UPIN