Provider Demographics
NPI:1629579222
Name:HUNTER FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:HUNTER FAMILY CHIROPRACTIC INC.
Other - Org Name:ACTIVESPINE HEALTH & INJURY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-515-8885
Mailing Address - Street 1:4893 ROCHESTER RD STE E
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4971
Mailing Address - Country:US
Mailing Address - Phone:248-509-7628
Mailing Address - Fax:
Practice Address - Street 1:4893 ROCHESTER RD STE E
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4971
Practice Address - Country:US
Practice Address - Phone:248-509-7628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4740719Medicaid