Provider Demographics
NPI:1619179942
Name:SUPERIOR FAMILY CHIROPRATIC INC
Entity Type:Organization
Organization Name:SUPERIOR FAMILY CHIROPRATIC INC
Other - Org Name:ANN ARBOR INSTITUTE FOR SPINAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:GRENILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-213-5805
Mailing Address - Street 1:5740 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9312
Mailing Address - Country:US
Mailing Address - Phone:734-213-5805
Mailing Address - Fax:734-213-5872
Practice Address - Street 1:5740 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9312
Practice Address - Country:US
Practice Address - Phone:734-213-5805
Practice Address - Fax:734-213-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H11230OtherBCBSM
MI0P13010Medicare PIN
MI0H11230OtherBCBSM