Provider Demographics
NPI:1508944679
Name:BERRIEN FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:BERRIEN FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSAMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOANES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-683-1700
Mailing Address - Street 1:2028 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4074
Mailing Address - Country:US
Mailing Address - Phone:269-683-1700
Mailing Address - Fax:269-683-7038
Practice Address - Street 1:2028 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4074
Practice Address - Country:US
Practice Address - Phone:269-683-1700
Practice Address - Fax:269-683-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU89635Medicare UPIN
MIP11030Medicare ID - Type UnspecifiedMEDICARE