Provider Demographics
NPI:1346385226
Name:DR. VINCENT A. ACKERMAN, D.C.,P.C.
Entity Type:Organization
Organization Name:DR. VINCENT A. ACKERMAN, D.C.,P.C.
Other - Org Name:ACKERMAN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-429-1710
Mailing Address - Street 1:2944 SUNDANCE PATH
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9380
Mailing Address - Country:US
Mailing Address - Phone:269-429-1710
Mailing Address - Fax:269-429-5578
Practice Address - Street 1:2560 S CLEVELAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2640
Practice Address - Country:US
Practice Address - Phone:269-982-1611
Practice Address - Fax:269-982-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N91480Medicare ID - Type Unspecified