Provider Demographics
NPI:1467623413
Name:NEW DEERFIELD CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:NEW DEERFIELD CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KOTCHOUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:ECT
Authorized Official - Phone:810-793-7376
Mailing Address - Street 1:6229 WILLITS RD
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:MI
Mailing Address - Zip Code:48435-9420
Mailing Address - Country:US
Mailing Address - Phone:810-793-7376
Mailing Address - Fax:810-793-7647
Practice Address - Street 1:5830 N LAPEER RD
Practice Address - Street 2:STE B.
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-9660
Practice Address - Country:US
Practice Address - Phone:810-793-7376
Practice Address - Fax:810-793-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty