Provider Demographics
NPI:1528360351
Name:A CHIRO-EFFECT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:A CHIRO-EFFECT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIEDERHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-327-4813
Mailing Address - Street 1:7117 S WESTNEDGE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-4201
Mailing Address - Country:US
Mailing Address - Phone:269-327-4813
Mailing Address - Fax:
Practice Address - Street 1:7117 S WESTNEDGE AVE STE 3
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4201
Practice Address - Country:US
Practice Address - Phone:269-327-4813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386876944OtherTYPE I NPI