Provider Demographics
NPI:1689099954
Name:PROACTIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:PROACTIVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MESKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-945-1011
Mailing Address - Street 1:350 N MAIN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1370
Mailing Address - Country:US
Mailing Address - Phone:734-945-1011
Mailing Address - Fax:
Practice Address - Street 1:350 N MAIN ST
Practice Address - Street 2:STE 210
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1370
Practice Address - Country:US
Practice Address - Phone:734-945-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty