Provider Demographics
NPI:1881854164
Name:SPECIALIZED FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SPECIALIZED FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:OSTERHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-324-4143
Mailing Address - Street 1:8150 MOORSBRIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024
Mailing Address - Country:US
Mailing Address - Phone:269-324-4143
Mailing Address - Fax:269-324-0755
Practice Address - Street 1:8150 MOORSBRIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-323-4473
Practice Address - Fax:269-324-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C91557OtherBCBS
MI950C912020Medicare UPIN
MI0C91557OtherBCBS