Provider Demographics
NPI:1164963310
Name:TRI-CITY SOFT TISSUE & SPINE PLLC
Entity Type:Organization
Organization Name:TRI-CITY SOFT TISSUE & SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-751-3979
Mailing Address - Street 1:810 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4716
Mailing Address - Country:US
Mailing Address - Phone:989-751-3979
Mailing Address - Fax:989-548-6033
Practice Address - Street 1:810 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4716
Practice Address - Country:US
Practice Address - Phone:989-751-3979
Practice Address - Fax:989-548-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty