Provider Demographics
NPI:1619933595
Name:ABIES CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:ABIES CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KUBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-344-1133
Mailing Address - Street 1:1511 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001
Mailing Address - Country:US
Mailing Address - Phone:269-344-1133
Mailing Address - Fax:269-344-4415
Practice Address - Street 1:1511 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001
Practice Address - Country:US
Practice Address - Phone:269-344-1133
Practice Address - Fax:269-344-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherCOMMERCIAL INS
MI=========OtherWORKERS COMP
=========OtherCOMMERCIAL INS