Provider Demographics
NPI:1508180746
Name:NORTHSTAR CHIROPRACTIC PC
Entity Type:Organization
Organization Name:NORTHSTAR CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SENG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-843-8200
Mailing Address - Street 1:311 S RATH AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2041
Mailing Address - Country:US
Mailing Address - Phone:231-843-8200
Mailing Address - Fax:231-425-3333
Practice Address - Street 1:311 S RATH AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2041
Practice Address - Country:US
Practice Address - Phone:231-843-8200
Practice Address - Fax:231-425-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty