Provider Demographics
NPI:1972704898
Name:CHIROPRACTIC PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-771-4550
Mailing Address - Street 1:30556 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1528
Mailing Address - Country:US
Mailing Address - Phone:586-771-4550
Mailing Address - Fax:586-771-4919
Practice Address - Street 1:30556 UTICA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1528
Practice Address - Country:US
Practice Address - Phone:586-771-4550
Practice Address - Fax:586-771-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06244Medicare PIN
MIT33171Medicare UPIN