Provider Demographics
NPI:1093202426
Name:PLATINUM CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:PLATINUM CHIROPRACTIC, PC
Other - Org Name:PRECISION CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-590-0236
Mailing Address - Street 1:1258 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6900
Mailing Address - Country:US
Mailing Address - Phone:248-590-0236
Mailing Address - Fax:
Practice Address - Street 1:1258 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6900
Practice Address - Country:US
Practice Address - Phone:248-590-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty