Provider Demographics
NPI:1700228608
Name:BIG CREEK CHIROPRACTIC & NUTRITION PLLC
Entity Type:Organization
Organization Name:BIG CREEK CHIROPRACTIC & NUTRITION PLLC
Other - Org Name:CENTER OF NATURAL THERAPIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-889-1477
Mailing Address - Street 1:2172 DEETER RD
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:MI
Mailing Address - Zip Code:48636-9775
Mailing Address - Country:US
Mailing Address - Phone:989-889-1477
Mailing Address - Fax:989-333-5900
Practice Address - Street 1:2172 DEETER RD
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:MI
Practice Address - Zip Code:48636-9775
Practice Address - Country:US
Practice Address - Phone:989-889-1477
Practice Address - Fax:989-333-5900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIG CREEK CHIROPRACTIC & NUTRITION PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-22
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487756987OtherBCBS