Provider Demographics
NPI:1598856874
Name:PROSPER FAMILY CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:PROSPER FAMILY CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROSPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-616-0900
Mailing Address - Street 1:4203 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2729
Mailing Address - Country:US
Mailing Address - Phone:248-616-0900
Mailing Address - Fax:248-616-1911
Practice Address - Street 1:4203 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2729
Practice Address - Country:US
Practice Address - Phone:248-616-0900
Practice Address - Fax:248-616-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP1787002Medicare ID - Type UnspecifiedMEDICARE NUMBER