Provider Demographics
NPI:1932466398
Name:CHIROPRACTIC PROFESSIONAL CENTER, PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC PROFESSIONAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-485-0001
Mailing Address - Street 1:1701 LAKE LANSING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3798
Mailing Address - Country:US
Mailing Address - Phone:517-485-0001
Mailing Address - Fax:
Practice Address - Street 1:3400 PINETREE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4286
Practice Address - Country:US
Practice Address - Phone:517-485-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty