Provider Demographics
NPI:1093848061
Name:TRI COUNTY CHIROPRACTIC OF MICHIGAN INC.
Entity Type:Organization
Organization Name:TRI COUNTY CHIROPRACTIC OF MICHIGAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-750-2600
Mailing Address - Street 1:4033 OWEN RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9100
Mailing Address - Country:US
Mailing Address - Phone:810-750-2600
Mailing Address - Fax:810-750-6981
Practice Address - Street 1:4033 OWEN RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-9100
Practice Address - Country:US
Practice Address - Phone:810-750-2600
Practice Address - Fax:810-750-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF35278Medicare ID - Type Unspecified