Provider Demographics
NPI:1114121001
Name:KALKASKA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:KALKASKA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHUMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-258-8678
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-0166
Mailing Address - Country:US
Mailing Address - Phone:231-258-8678
Mailing Address - Fax:231-258-2719
Practice Address - Street 1:224 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646
Practice Address - Country:US
Practice Address - Phone:231-258-8678
Practice Address - Fax:231-258-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS002791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4348368Medicaid