Provider Demographics
NPI:1023298965
Name:CHADWELL CHIROPRACTIC OF MIDLAND LLC
Entity type:Organization
Organization Name:CHADWELL CHIROPRACTIC OF MIDLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:LANGE
Authorized Official - Last Name:CHADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-832-3066
Mailing Address - Street 1:5103 EASTMAN AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6785
Mailing Address - Country:US
Mailing Address - Phone:989-832-3066
Mailing Address - Fax:989-832-3066
Practice Address - Street 1:5103 EASTMAN AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6785
Practice Address - Country:US
Practice Address - Phone:989-832-3066
Practice Address - Fax:989-832-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E61188OtherBCBSM
MIP97364OtherBLUE CARE NETWORK
MI3083544Medicaid
MI950E61188OtherBCBSM