Provider Demographics
NPI:1285819169
Name:ST. JOHNS CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:ST. JOHNS CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:MASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-224-8228
Mailing Address - Street 1:1004 N US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1129
Mailing Address - Country:US
Mailing Address - Phone:989-224-8228
Mailing Address - Fax:
Practice Address - Street 1:1004 N US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1129
Practice Address - Country:US
Practice Address - Phone:989-224-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285819169Medicare PIN
MI1992830038Medicare PIN