Provider Demographics
NPI:1083826119
Name:POOLE CHIROPRACTIC INC PC
Entity Type:Organization
Organization Name:POOLE CHIROPRACTIC INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:LU
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-773-1816
Mailing Address - Street 1:2705 S ISABELLA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2067
Mailing Address - Country:US
Mailing Address - Phone:989-773-1816
Mailing Address - Fax:
Practice Address - Street 1:2705 S ISABELLA RD
Practice Address - Street 2:SUITE B
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2067
Practice Address - Country:US
Practice Address - Phone:989-773-1816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC75006001OtherMEDICARE PROVIDER #
MIC75006001OtherMEDICARE PROVIDER #
MI0C75006Medicare PIN