Provider Demographics
NPI:1790029874
Name:MANCHESTER FAMILY CHIROPRACTIC CENTER PLC
Entity Type:Organization
Organization Name:MANCHESTER FAMILY CHIROPRACTIC CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-962-2178
Mailing Address - Street 1:3634 MCCAIN RD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2576
Mailing Address - Country:US
Mailing Address - Phone:517-962-2178
Mailing Address - Fax:517-962-2399
Practice Address - Street 1:3634 MCCAIN RD
Practice Address - Street 2:UNIT 7
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2576
Practice Address - Country:US
Practice Address - Phone:517-962-2178
Practice Address - Fax:517-962-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI201008155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6442Medicare PIN