Provider Demographics
NPI:1437215639
Name:COMPLETE CHIROPRACTIC CARE, INC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORRINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FRIDLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-694-8031
Mailing Address - Street 1:11225 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1285
Mailing Address - Country:US
Mailing Address - Phone:810-694-8031
Mailing Address - Fax:810-736-3122
Practice Address - Street 1:11225 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1285
Practice Address - Country:US
Practice Address - Phone:810-694-8031
Practice Address - Fax:810-736-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICF007120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP75997OtherBCN
MI3239707Medicaid
MI9493455001OtherCIGNA
MIG06353OtherBCM
MI604354OtherACN MCARE
MIP106543OtherBCM
MI132239OtherASHN
MI3239707Medicaid
MI0M06410Medicare ID - Type Unspecified