Provider Demographics
NPI:1558555771
Name:NEWAYGO CHIROPRACTIC CENTER P.C.
Entity Type:Organization
Organization Name:NEWAYGO CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC ROUNDS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-652-4523
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-0901
Mailing Address - Country:US
Mailing Address - Phone:231-652-4523
Mailing Address - Fax:231-652-4513
Practice Address - Street 1:38 STATE RD
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-7926
Practice Address - Country:US
Practice Address - Phone:231-652-4523
Practice Address - Fax:231-652-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P09740Medicare UPIN