Provider Demographics
NPI:1164894648
Name:NORTHERN LIGHTS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:NORTHERN LIGHTS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-510-8682
Mailing Address - Street 1:2506 CROSSING CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7955
Mailing Address - Country:US
Mailing Address - Phone:231-421-3333
Mailing Address - Fax:231-421-3355
Practice Address - Street 1:2506 CROSSING CIR
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7955
Practice Address - Country:US
Practice Address - Phone:231-421-3333
Practice Address - Fax:231-421-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty