Provider Demographics
NPI:1467602938
Name:MCCARTNEY CHIROPRACTIC LIFE CENTER INC
Entity Type:Organization
Organization Name:MCCARTNEY CHIROPRACTIC LIFE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-462-6470
Mailing Address - Street 1:37691 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1050
Mailing Address - Country:US
Mailing Address - Phone:734-462-6470
Mailing Address - Fax:
Practice Address - Street 1:37691 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-462-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKM005811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID