Provider Demographics
NPI:1730304148
Name:MCNINCH CHIROPRACTIC CENTER, L.L.C.
Entity Type:Organization
Organization Name:MCNINCH CHIROPRACTIC CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCNINCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-754-4621
Mailing Address - Street 1:1100 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1132
Mailing Address - Country:US
Mailing Address - Phone:616-754-4621
Mailing Address - Fax:616-754-4679
Practice Address - Street 1:1100 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1132
Practice Address - Country:US
Practice Address - Phone:616-754-4621
Practice Address - Fax:616-754-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM007870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4374626Medicaid
MA4374626Medicaid
ON40910Medicare ID - Type UnspecifiedMEDICARE
MION40910Medicare PIN