Provider Demographics
NPI:1477185312
Name:100 PERCENT CHIROPRACTIC SANTOS, LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC SANTOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-206-4294
Mailing Address - Street 1:2321 E BELTLINE AVE NE STE D
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9803
Mailing Address - Country:US
Mailing Address - Phone:616-206-4294
Mailing Address - Fax:
Practice Address - Street 1:2321 E BELTLINE AVE NE STE D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9803
Practice Address - Country:US
Practice Address - Phone:616-206-4294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301010863Medicaid