Provider Demographics
NPI:1922283365
Name:LIFEPOINTE CHIROPRACTIC CENTER, PLC
Entity Type:Organization
Organization Name:LIFEPOINTE CHIROPRACTIC CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RAMBOER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-623-6107
Mailing Address - Street 1:5896 DIXIE HWY
Mailing Address - Street 2:STE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3358
Mailing Address - Country:US
Mailing Address - Phone:248-623-6107
Mailing Address - Fax:248-623-6443
Practice Address - Street 1:5896 DIXIE HWY
Practice Address - Street 2:STE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3358
Practice Address - Country:US
Practice Address - Phone:248-623-6107
Practice Address - Fax:248-623-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGR008055111N00000X
MIRR008207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N30330Medicare PIN