Provider Demographics
NPI:1598840274
Name:PICHE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:PICHE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PICHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-995-0990
Mailing Address - Street 1:1832 OAK HOLLOW DR
Mailing Address - Street 2:B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5918
Mailing Address - Country:US
Mailing Address - Phone:231-995-0990
Mailing Address - Fax:231-995-0991
Practice Address - Street 1:1832 OAK HOLLOW DR
Practice Address - Street 2:B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5918
Practice Address - Country:US
Practice Address - Phone:231-995-0990
Practice Address - Fax:231-995-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU77379Medicare UPIN