Provider Demographics
NPI:1427216035
Name:MADISON HEIGHTS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MADISON HEIGHTS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:KASH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-542-3492
Mailing Address - Street 1:28107 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2810
Mailing Address - Country:US
Mailing Address - Phone:248-542-3492
Mailing Address - Fax:248-542-3494
Practice Address - Street 1:28107 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2810
Practice Address - Country:US
Practice Address - Phone:248-542-3492
Practice Address - Fax:248-542-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002589261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F315670OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1071929Medicaid
MIT33356Medicare UPIN
MI1071929Medicaid