Provider Demographics
NPI:1487831210
Name:JDK CENTERS INC
Entity Type:Organization
Organization Name:JDK CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KRIBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-589-5610
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:MI
Mailing Address - Zip Code:49251-0515
Mailing Address - Country:US
Mailing Address - Phone:517-589-5610
Mailing Address - Fax:517-589-9908
Practice Address - Street 1:522 W BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:MI
Practice Address - Zip Code:49251-9490
Practice Address - Country:US
Practice Address - Phone:517-589-5610
Practice Address - Fax:517-589-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3040387Medicaid
MI3040387Medicaid
MI0P03330Medicare PIN
MI=========OtherCOMMERCIAL