Provider Demographics
NPI:1801834288
Name:SUTHERLAND FAMILY CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:SUTHERLAND FAMILY CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-486-3008
Mailing Address - Street 1:120 E. ADRIAN ST
Mailing Address - Street 2:D
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-1254
Mailing Address - Country:US
Mailing Address - Phone:517-486-3008
Mailing Address - Fax:517-486-5669
Practice Address - Street 1:120 E ADRIAN ST
Practice Address - Street 2:D
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-1254
Practice Address - Country:US
Practice Address - Phone:517-486-3008
Practice Address - Fax:517-486-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS004601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI04128OtherPARAMOUNT
MI769311OtherFIRST HEALTH
MI769311OtherFIRST HEALTH
MI0D65026Medicare PIN
MIMI4045Medicare PIN