Provider Demographics
NPI:1386856573
Name:HEALTH CHOICE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEALTH CHOICE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFTHIMIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERISTERIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-760-3994
Mailing Address - Street 1:2913 BRANDYWINE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008
Mailing Address - Country:US
Mailing Address - Phone:269-760-3994
Mailing Address - Fax:
Practice Address - Street 1:141 E MICHIGAN AVE
Practice Address - Street 2:STE 201
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-373-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU72633Medicare UPIN
MIOM71600Medicare ID - Type Unspecified