Provider Demographics
NPI:1164869228
Name:NORTH BRIDGE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:NORTH BRIDGE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-924-9213
Mailing Address - Street 1:42000 6 MILE RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4336
Mailing Address - Country:US
Mailing Address - Phone:248-924-9213
Mailing Address - Fax:
Practice Address - Street 1:42000 6 MILE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4336
Practice Address - Country:US
Practice Address - Phone:248-924-9213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty