Provider Demographics
NPI:1497128649
Name:DELTA CHIROPRACTIC CENTER OF LANSING
Entity Type:Organization
Organization Name:DELTA CHIROPRACTIC CENTER OF LANSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROOST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-321-3030
Mailing Address - Street 1:6130 W SAGINAW HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2465
Mailing Address - Country:US
Mailing Address - Phone:517-321-3030
Mailing Address - Fax:517-321-7015
Practice Address - Street 1:6130 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2465
Practice Address - Country:US
Practice Address - Phone:517-321-3030
Practice Address - Fax:517-321-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004303261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B31124OtherBCBS
MI0B35025Medicaid
MIP00216640OtherMEDICARE RR
MI0B35025OtherMEDICARE