Provider Demographics
NPI:1609061480
Name:DOC SIDE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DOC SIDE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HARTOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-201-9020
Mailing Address - Street 1:32801 REDBUD PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1490
Mailing Address - Country:US
Mailing Address - Phone:586-201-9020
Mailing Address - Fax:586-648-2648
Practice Address - Street 1:32801 REDBUD PKWY
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1490
Practice Address - Country:US
Practice Address - Phone:586-201-9020
Practice Address - Fax:586-648-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty