Provider Demographics
NPI:1346360815
Name:DR MINIONS ALTERNATIVE CARE LLC
Entity Type:Organization
Organization Name:DR MINIONS ALTERNATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:YALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-477-5709
Mailing Address - Street 1:9883 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:MI
Mailing Address - Zip Code:48191-8000
Mailing Address - Country:US
Mailing Address - Phone:734-477-5709
Mailing Address - Fax:
Practice Address - Street 1:6231 N CANTON CENTER RD
Practice Address - Street 2:STE. 109
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2694
Practice Address - Country:US
Practice Address - Phone:734-477-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB0121TOtherLLC ID#