Provider Demographics
NPI:1952845729
Name:MISSION CHIROPRACTIC FAMILY CENTER, P.C.
Entity Type:Organization
Organization Name:MISSION CHIROPRACTIC FAMILY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-615-1988
Mailing Address - Street 1:11245 N MISSION RD
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9301
Mailing Address - Country:US
Mailing Address - Phone:989-386-5437
Mailing Address - Fax:989-386-4442
Practice Address - Street 1:11245 N MISSION RD
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9301
Practice Address - Country:US
Practice Address - Phone:989-386-5437
Practice Address - Fax:989-386-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITH009053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4775643Medicaid