Provider Demographics
NPI:1407449796
Name:CANTON FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CANTON FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MORABITO
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:734-667-5218
Mailing Address - Street 1:42287 CHERRY HILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1976
Mailing Address - Country:US
Mailing Address - Phone:734-667-5218
Mailing Address - Fax:734-667-5287
Practice Address - Street 1:42287 CHERRY HILL RD STE D
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1976
Practice Address - Country:US
Practice Address - Phone:734-667-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301009974OtherSTATE LICENSE