Provider Demographics
NPI:1619733763
Name:CROSSROADS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC, PLLC
Other - Org Name:CROSSROADS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-740-5485
Mailing Address - Street 1:18875 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:CEMENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49233-9005
Mailing Address - Country:US
Mailing Address - Phone:517-740-5485
Mailing Address - Fax:
Practice Address - Street 1:18875 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:CEMENT CITY
Practice Address - State:MI
Practice Address - Zip Code:49233-9005
Practice Address - Country:US
Practice Address - Phone:517-442-4805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty