Provider Demographics
NPI:1225281652
Name:CHESTERFIELD FAMILY CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CHESTERFIELD FAMILY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-948-7246
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-5171
Mailing Address - Country:US
Mailing Address - Phone:586-948-7246
Mailing Address - Fax:586-948-2748
Practice Address - Street 1:28039 CARRIAGE WAY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2101
Practice Address - Country:US
Practice Address - Phone:586-948-7246
Practice Address - Fax:586-948-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N62880Medicare PIN