Provider Demographics
NPI:1407270424
Name:MID-MICHIGAN SPORT & SPINE
Entity Type:Organization
Organization Name:MID-MICHIGAN SPORT & SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-253-8123
Mailing Address - Street 1:3303 W SAGINAW ST
Mailing Address - Street 2:SUITE A14
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2303
Mailing Address - Country:US
Mailing Address - Phone:517-253-8123
Mailing Address - Fax:517-253-8124
Practice Address - Street 1:3303 W SAGINAW ST
Practice Address - Street 2:SUITE A14
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2303
Practice Address - Country:US
Practice Address - Phone:517-253-8123
Practice Address - Fax:517-253-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1497988455OtherNPI