Provider Demographics
NPI:1124211933
Name:SEMLOW CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SEMLOW CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-247-7020
Mailing Address - Street 1:15373 HALL RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-3841
Mailing Address - Country:US
Mailing Address - Phone:586-247-7020
Mailing Address - Fax:
Practice Address - Street 1:15373 HALL RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-3841
Practice Address - Country:US
Practice Address - Phone:586-247-7020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKS300293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P14560Medicare PIN
MIU26753Medicare UPIN