Provider Demographics
NPI:1245408301
Name:SAM CHAN PC
Entity Type:Organization
Organization Name:SAM CHAN PC
Other - Org Name:CHIROMED CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-729-2273
Mailing Address - Street 1:1010 E M 21
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9007
Mailing Address - Country:US
Mailing Address - Phone:989-729-2273
Mailing Address - Fax:989-723-4836
Practice Address - Street 1:1010 E M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9007
Practice Address - Country:US
Practice Address - Phone:989-729-2273
Practice Address - Fax:989-723-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G810860OtherBCBSM
MIV02656Medicare UPIN
MI950G810860OtherBCBSM
MI0P55550Medicare PIN