Provider Demographics
NPI:1225551096
Name:MICHIGAN'S FAMILY CHIROPRACTIC- EATON RAPIDS, PLLC
Entity Type:Organization
Organization Name:MICHIGAN'S FAMILY CHIROPRACTIC- EATON RAPIDS, PLLC
Other - Org Name:EATON RAPIDS FAMILY CHIROPRACTIC, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:TAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-629-5506
Mailing Address - Street 1:1467 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1467 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1937
Practice Address - Country:US
Practice Address - Phone:517-629-5506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty