Provider Demographics
NPI:1760954697
Name:BIG RAPIDS CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:BIG RAPIDS CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONETZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-396-6635
Mailing Address - Street 1:258 JAMES ST STE 10
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1806
Mailing Address - Country:US
Mailing Address - Phone:616-396-6635
Mailing Address - Fax:
Practice Address - Street 1:109 S WARREN AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1843
Practice Address - Country:US
Practice Address - Phone:231-796-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301009161OtherSTATE OF MICHIGAN