Provider Demographics
NPI:1588800601
Name:SCHAFER CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:SCHAFER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-301-3000
Mailing Address - Street 1:1801 BRETON RD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4807
Mailing Address - Country:US
Mailing Address - Phone:616-301-3000
Mailing Address - Fax:616-301-2909
Practice Address - Street 1:1801 BRETON RD SE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4807
Practice Address - Country:US
Practice Address - Phone:616-301-3000
Practice Address - Fax:616-301-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty