Provider Demographics
NPI:1083871644
Name:NORTH MACOMB CHIROPRACTIC PC
Entity Type:Organization
Organization Name:NORTH MACOMB CHIROPRACTIC PC
Other - Org Name:SARVER CHIROPRACTIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:KAYLOR
Authorized Official - Last Name:SARVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-781-0800
Mailing Address - Street 1:57911 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-2763
Mailing Address - Country:US
Mailing Address - Phone:586-781-0800
Mailing Address - Fax:586-781-2426
Practice Address - Street 1:57911 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-2763
Practice Address - Country:US
Practice Address - Phone:586-781-0800
Practice Address - Fax:586-781-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV10726Medicare UPIN
MI0N26050Medicare PIN