Provider Demographics
NPI:1023124120
Name:DOWNRIVER INDUSTRIAL CLINIC PC
Entity type:Organization
Organization Name:DOWNRIVER INDUSTRIAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-382-4288
Mailing Address - Street 1:4005 W JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229
Mailing Address - Country:US
Mailing Address - Phone:313-382-4288
Mailing Address - Fax:
Practice Address - Street 1:4005 W JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229
Practice Address - Country:US
Practice Address - Phone:313-382-4288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH002423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4347487-14Medicaid
MIP25752FOtherBLUE CARE NETWORK
MIU53793Medicare ID - Type Unspecified
MIP25752FOtherBLUE CARE NETWORK