Provider Demographics
NPI:1598003717
Name:FAMILY CHIROPRACTIC HEALTHCARE CENTER, PLLC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC HEALTHCARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:VANGESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-363-7713
Mailing Address - Street 1:4612 PLAINFIELD AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4612 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1229
Practice Address - Country:US
Practice Address - Phone:616-363-7713
Practice Address - Fax:616-363-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005052111N00000X
MI2301009813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty