Provider Demographics
NPI:1659325009
Name:INNERLINK CHIROPRACTIC
Entity Type:Organization
Organization Name:INNERLINK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-349-0300
Mailing Address - Street 1:28345 BECK RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-4733
Mailing Address - Country:US
Mailing Address - Phone:248-349-0300
Mailing Address - Fax:248-349-0307
Practice Address - Street 1:28345 BECK RD
Practice Address - Street 2:SUITE 412
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-4733
Practice Address - Country:US
Practice Address - Phone:248-349-0300
Practice Address - Fax:248-349-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008931305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F328180OtherBCBS
MIOP31710Medicare PIN