Provider Demographics
NPI:1811224249
Name:HEALTHWAY CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:HEALTHWAY CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MILFORD
Authorized Official - Last Name:OSTERGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-631-0207
Mailing Address - Street 1:630 HILLCREST RD.
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-631-0207
Mailing Address - Fax:
Practice Address - Street 1:702 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4907
Practice Address - Country:US
Practice Address - Phone:989-631-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301001654261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE65006OtherBLUE CROSS BLUE SHIELD
TX7246831OtherAETNA
TX7246831OtherAETNA
MIT82651Medicare UPIN