Provider Demographics
NPI:1235301839
Name:DR R L CHORPENNING, PC
Entity Type:Organization
Organization Name:DR R L CHORPENNING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:CHORPENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-651-4920
Mailing Address - Street 1:104 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1770
Mailing Address - Country:US
Mailing Address - Phone:269-651-3652
Mailing Address - Fax:
Practice Address - Street 1:104 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1770
Practice Address - Country:US
Practice Address - Phone:269-651-3652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRC002499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1009412Medicaid
MI0G55014Medicare PIN