Provider Demographics
NPI:1245387984
Name:SIMINSKI CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:SIMINSKI CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SIMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-723-2039
Mailing Address - Street 1:210 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-723-2039
Mailing Address - Fax:989-725-7723
Practice Address - Street 1:210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2914
Practice Address - Country:US
Practice Address - Phone:989-723-2039
Practice Address - Fax:989-725-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS002729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4429081Medicaid
MI4429081Medicaid