Provider Demographics
NPI:1497048565
Name:EVERINGHAM CHIROPRACTIC HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:EVERINGHAM CHIROPRACTIC HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EVERINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-941-5620
Mailing Address - Street 1:12100 S HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1119
Mailing Address - Country:US
Mailing Address - Phone:734-941-5620
Mailing Address - Fax:
Practice Address - Street 1:12100 S HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1119
Practice Address - Country:US
Practice Address - Phone:734-941-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU94928Medicare UPIN
0N76120Medicare PIN