Provider Demographics
NPI:1497085344
Name:CROSSROADS FAMILY CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:CROSSROADS FAMILY CHIROPRACTIC CENTER, PC
Other - Org Name:CROSSROADS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:YAPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-486-4931
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-0067
Mailing Address - Country:US
Mailing Address - Phone:517-486-4931
Mailing Address - Fax:517-486-3026
Practice Address - Street 1:9996 E US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-9688
Practice Address - Country:US
Practice Address - Phone:517-486-4931
Practice Address - Fax:517-486-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306842512OtherMEDICARE FORMER NPI
MI020554885Medicaid
MI020554885Medicaid