Provider Demographics
NPI:1831463728
Name:GREATER NILES CHIROPRACTIC HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:GREATER NILES CHIROPRACTIC HEALTH CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-683-8151
Mailing Address - Street 1:2407 YANKEE ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-3955
Mailing Address - Country:US
Mailing Address - Phone:269-683-8151
Mailing Address - Fax:269-683-6112
Practice Address - Street 1:2407 YANKEE ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3955
Practice Address - Country:US
Practice Address - Phone:269-683-8151
Practice Address - Fax:269-683-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23010006540261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2594620Medicaid
OA45277Medicare PIN
T97323Medicare UPIN