Provider Demographics
NPI:1710126925
Name:PRIORITY CHIROPRACTIC
Entity Type:Organization
Organization Name:PRIORITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:VANDERSLUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-696-8916
Mailing Address - Street 1:2072B E COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2116
Mailing Address - Country:US
Mailing Address - Phone:219-696-8916
Mailing Address - Fax:219-696-6880
Practice Address - Street 1:2072B E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2116
Practice Address - Country:US
Practice Address - Phone:219-696-8916
Practice Address - Fax:219-696-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001448A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1699820241OtherBCBS 000000380552
IN1154338945OtherBCBS 000000499830