Provider Demographics
NPI:1629124326
Name:LOGAN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:LOGAN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-751-1977
Mailing Address - Street 1:27104 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3537
Mailing Address - Country:US
Mailing Address - Phone:586-751-1977
Mailing Address - Fax:586-751-1929
Practice Address - Street 1:27104 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3537
Practice Address - Country:US
Practice Address - Phone:586-751-1977
Practice Address - Fax:586-751-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBL005438111N00000X
MICS008620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E001510OtherBLUE CROSS GROUP NUMBER
MI4510951Medicaid
MI950E001510OtherBLUE CROSS GROUP NUMBER
MIU34875Medicare UPIN