Provider Demographics
NPI:1932684131
Name:PROACTIVE CHIROPRACTIC CARE, PLC
Entity Type:Organization
Organization Name:PROACTIVE CHIROPRACTIC CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-547-0242
Mailing Address - Street 1:7875 PORT HOPE DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4107
Mailing Address - Country:US
Mailing Address - Phone:269-547-0242
Mailing Address - Fax:
Practice Address - Street 1:635 N 9TH ST STE C
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5897
Practice Address - Country:US
Practice Address - Phone:269-547-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty