Provider Demographics
NPI:1245414069
Name:NORRIS CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:NORRIS CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-324-3131
Mailing Address - Street 1:3719 S WESTNEDGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2979
Mailing Address - Country:US
Mailing Address - Phone:269-324-3131
Mailing Address - Fax:269-329-2983
Practice Address - Street 1:3719 S WESTNEDGE AVE STE B
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2979
Practice Address - Country:US
Practice Address - Phone:269-324-3131
Practice Address - Fax:269-329-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILN006036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
950C950570OtherBLUE CROSS BLUE SHIELD
MI950C964110OtherBLUE CROSS BLUE SHIELD