Provider Demographics
NPI:1114938693
Name:PRATER CHIROPRACTIC WELLNESS CENTER INC
Entity Type:Organization
Organization Name:PRATER CHIROPRACTIC WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-5021
Mailing Address - Street 1:903 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4661
Mailing Address - Country:US
Mailing Address - Phone:269-343-5021
Mailing Address - Fax:269-343-5022
Practice Address - Street 1:903 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4661
Practice Address - Country:US
Practice Address - Phone:269-343-5021
Practice Address - Fax:269-343-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23010077517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4430153OtherIBA
U67975Medicare UPIN
ON43520Medicare ID - Type Unspecified