Provider Demographics
NPI:1912028796
Name:CHIROPRACTIC ASSOCIATES OF MICHIGAN
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:BERT
Authorized Official - Last Name:LIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-293-4440
Mailing Address - Street 1:10074 BORGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1103
Mailing Address - Country:US
Mailing Address - Phone:248-541-1649
Mailing Address - Fax:
Practice Address - Street 1:31850 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-1983
Practice Address - Country:US
Practice Address - Phone:586-293-4440
Practice Address - Fax:586-293-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E051610OtherBCBS OF MICHIGAN
MIN26900001Medicare PIN