Provider Demographics
NPI:1669502654
Name:CEDAR SPRINGS FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CEDAR SPRINGS FAMILY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-696-2663
Mailing Address - Street 1:151 S MAIN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8950
Mailing Address - Country:US
Mailing Address - Phone:616-696-2688
Mailing Address - Fax:616-696-2663
Practice Address - Street 1:151 S MAIN
Practice Address - Street 2:SUITE 4
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8950
Practice Address - Country:US
Practice Address - Phone:616-696-2688
Practice Address - Fax:616-696-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGB007557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4974905Medicaid
MI4974905Medicaid
MIM83400001Medicare PIN