Provider Demographics
NPI:1497944391
Name:MY FAMILY CHIROPRACTOR, P.C.
Entity Type:Organization
Organization Name:MY FAMILY CHIROPRACTOR, P.C.
Other - Org Name:MID MICHIGAN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SAWAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-426-6121
Mailing Address - Street 1:120 COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1220
Mailing Address - Country:US
Mailing Address - Phone:989-426-6121
Mailing Address - Fax:989-426-5466
Practice Address - Street 1:120 COMMERCE CT
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1220
Practice Address - Country:US
Practice Address - Phone:989-426-6121
Practice Address - Fax:989-426-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS005236111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1814784Medicaid
0B66234Medicare PIN