Provider Demographics
NPI:1861659088
Name:CHELSEA CHIROPRACTIC CENTER, PLC
Entity Type:Organization
Organization Name:CHELSEA CHIROPRACTIC CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GILLARD
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:734-475-2932
Mailing Address - Street 1:901 TAYLOR ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-2301
Mailing Address - Country:US
Mailing Address - Phone:734-475-2932
Mailing Address - Fax:734-475-1885
Practice Address - Street 1:901 TAYLOR ST
Practice Address - Street 2:SUITE C
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-2301
Practice Address - Country:US
Practice Address - Phone:734-475-2932
Practice Address - Fax:734-475-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJD006131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H150960OtherBLUE CROSS BLUE SHIELD
MI1114075264OtherINDIVIDUAL NPI
MIU40986Medicare UPIN
MI1114075264OtherINDIVIDUAL NPI