Provider Demographics
NPI:1376634451
Name:NORTHSHORE CHIROPRACTIC CENTER,PC
Entity Type:Organization
Organization Name:NORTHSHORE CHIROPRACTIC CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:SEIEROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-744-8277
Mailing Address - Street 1:485 WHITEHALL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-3274
Mailing Address - Country:US
Mailing Address - Phone:231-744-8277
Mailing Address - Fax:231-744-0848
Practice Address - Street 1:485 WHITEHALL RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3274
Practice Address - Country:US
Practice Address - Phone:231-744-8277
Practice Address - Fax:231-744-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F150262000952Medicare ID - Type Unspecified