Provider Demographics
NPI:1598383390
Name:EASTSIDE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:EASTSIDE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-635-1585
Mailing Address - Street 1:19959 VERNIER RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1471
Mailing Address - Country:US
Mailing Address - Phone:313-635-1585
Mailing Address - Fax:313-635-1595
Practice Address - Street 1:19959 VERNIER RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1471
Practice Address - Country:US
Practice Address - Phone:313-635-1585
Practice Address - Fax:313-635-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty