Provider Demographics
NPI:1811196272
Name:NEW BOSTON CHIROPRACTIC LIFE CENTER, CORPORATION
Entity Type:Organization
Organization Name:NEW BOSTON CHIROPRACTIC LIFE CENTER, CORPORATION
Other - Org Name:TECUMSEH NECK AND BACK FAMILY CHIROPRACTIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:517-423-2639
Mailing Address - Street 1:405 E CHICAGO BLVD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1513
Mailing Address - Country:US
Mailing Address - Phone:517-423-2639
Mailing Address - Fax:517-423-0639
Practice Address - Street 1:405 E CHICAGO BLVD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1513
Practice Address - Country:US
Practice Address - Phone:517-423-2639
Practice Address - Fax:517-423-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0D60102-0OtherBLUE CROSS GROUP
MIP11040001OtherMEDICARE
MIP11040001OtherMEDICARE