Provider Demographics
NPI:1629103528
Name:HEALTHY FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:HEALTHY FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:VAHUE-RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-567-4111
Mailing Address - Street 1:4415 DUKE ST
Mailing Address - Street 2:SUITE #2 EAST
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3224
Mailing Address - Country:US
Mailing Address - Phone:269-567-4111
Mailing Address - Fax:269-567-4113
Practice Address - Street 1:4415 DUKE ST
Practice Address - Street 2:SUITE #2 EAST
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3224
Practice Address - Country:US
Practice Address - Phone:269-567-4111
Practice Address - Fax:269-567-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP2900001OtherMEDICARE PTAN
MI1629103528OtherDR.'S GROUP NPI
MI1114052115OtherDR.'S INDIVIDUAL NPI
950C91206OtherBLUE CROSS BLUE SHIELD PIN NUMBER
MI0P02900OtherMEDICARE GROUP NUMBER
MIP2900001OtherMEDICARE PTAN