Provider Demographics
NPI:1639317514
Name:THRIVE CHIROPRACTIC DEXTER P.C.
Entity Type:Organization
Organization Name:THRIVE CHIROPRACTIC DEXTER P.C.
Other - Org Name:SIMPSON FAMILY CHIROPRACTIC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-253-2114
Mailing Address - Street 1:3219 BROAD ST.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130
Mailing Address - Country:US
Mailing Address - Phone:734-253-2114
Mailing Address - Fax:734-253-2132
Practice Address - Street 1:3219 BROAD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130
Practice Address - Country:US
Practice Address - Phone:734-253-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MI2301008768305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2698OtherPTAN