Provider Demographics
NPI:1417229790
Name:MEAD CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MEAD CHIROPRACTIC PC
Other - Org Name:RELIEF CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-408-0303
Mailing Address - Street 1:3830 M 139 STE 119
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9609
Mailing Address - Country:US
Mailing Address - Phone:269-408-0303
Mailing Address - Fax:269-408-0083
Practice Address - Street 1:3830 M 139 STE 119
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9609
Practice Address - Country:US
Practice Address - Phone:269-408-0303
Practice Address - Fax:269-408-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty