Provider Demographics
NPI:1821260399
Name:VILLAGE CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:VILLAGE CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-863-9771
Mailing Address - Street 1:54 COURTLAND ST STE F
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1412
Mailing Address - Country:US
Mailing Address - Phone:616-863-9771
Mailing Address - Fax:616-863-9771
Practice Address - Street 1:54 COURTLAND ST STE F
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1412
Practice Address - Country:US
Practice Address - Phone:616-863-9771
Practice Address - Fax:616-863-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty