Provider Demographics
NPI:1558851378
Name:FALKNER FAMILY CHIROPRACTIC & SPORTS REHAB LLC
Entity Type:Organization
Organization Name:FALKNER FAMILY CHIROPRACTIC & SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-390-1499
Mailing Address - Street 1:5643 SASHABAW RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3149
Mailing Address - Country:US
Mailing Address - Phone:248-390-1499
Mailing Address - Fax:
Practice Address - Street 1:5643 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-390-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3739004Medicaid