Provider Demographics
NPI:1508886904
Name:ST. CLAIR CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:ST. CLAIR CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-329-9121
Mailing Address - Street 1:301 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5339
Mailing Address - Country:US
Mailing Address - Phone:810-329-9121
Mailing Address - Fax:810-329-3914
Practice Address - Street 1:301 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5339
Practice Address - Country:US
Practice Address - Phone:810-329-9121
Practice Address - Fax:810-329-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G411230OtherBCBS
MI0P37940Medicare ID - Type Unspecified