Provider Demographics
NPI:1083889984
Name:ALBION CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:ALBION CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-629-5505
Mailing Address - Street 1:404 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1845
Mailing Address - Country:US
Mailing Address - Phone:517-629-5505
Mailing Address - Fax:
Practice Address - Street 1:404 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1845
Practice Address - Country:US
Practice Address - Phone:517-629-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004500111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A35039OtherBLUE CROSS BLUE SHIELD
MI2115438Medicaid
P69466OtherBLUE CARE NETWORK
MI0A35039OtherBLUE CROSS BLUE SHIELD
T82869Medicare UPIN