Provider Demographics
NPI:1134112386
Name:ANCHOR CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ANCHOR CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARITA
Authorized Official - Last Name:FOXWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-471-1250
Mailing Address - Street 1:1945 TWIN SUN CIR
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-4404
Mailing Address - Country:US
Mailing Address - Phone:248-960-1465
Mailing Address - Fax:248-471-0964
Practice Address - Street 1:32595 GRAND RIVER
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-471-1250
Practice Address - Fax:248-471-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35210OtherBCBSM
MIP116444OtherBCN
Z33401Medicare UPIN
MI950F35210OtherBCBSM