Provider Demographics
NPI:1467860197
Name:PLANK CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PLANK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-406-4670
Mailing Address - Street 1:132 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1209
Mailing Address - Country:US
Mailing Address - Phone:269-792-9050
Mailing Address - Fax:616-281-2502
Practice Address - Street 1:132 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1209
Practice Address - Country:US
Practice Address - Phone:269-792-9050
Practice Address - Fax:616-281-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty