Provider Demographics
NPI:1144421603
Name:FREDERICK CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:FREDERICK CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-552-3132
Mailing Address - Street 1:1221 BYRON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1069
Mailing Address - Country:US
Mailing Address - Phone:517-552-3132
Mailing Address - Fax:517-552-8463
Practice Address - Street 1:1221 BYRON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1069
Practice Address - Country:US
Practice Address - Phone:517-552-3132
Practice Address - Fax:517-552-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301007587OtherLICENSE