Provider Demographics
NPI:1598103400
Name:ALL STAR PEDIATRIC & FAMILY CHIROPRACTIC PLC
Entity Type:Organization
Organization Name:ALL STAR PEDIATRIC & FAMILY CHIROPRACTIC PLC
Other - Org Name:ALL STAR CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-363-1797
Mailing Address - Street 1:378 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9327
Mailing Address - Country:US
Mailing Address - Phone:269-849-5728
Mailing Address - Fax:
Practice Address - Street 1:2640 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3002
Practice Address - Country:US
Practice Address - Phone:269-363-1797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty