Provider Demographics
NPI:1629603279
Name:NORTHERN STAR CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:NORTHERN STAR CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STOYNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-291-2300
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-0395
Mailing Address - Country:US
Mailing Address - Phone:906-291-2300
Mailing Address - Fax:906-291-2300
Practice Address - Street 1:224 NEWBERRY AVE
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-1103
Practice Address - Country:US
Practice Address - Phone:906-291-2300
Practice Address - Fax:906-291-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty