Provider Demographics
NPI:1184804528
Name:CEDAR CHIROPRACTIC, PC
Entity type:Organization
Organization Name:CEDAR CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-228-5233
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MI
Mailing Address - Zip Code:49621-0173
Mailing Address - Country:US
Mailing Address - Phone:231-228-5233
Mailing Address - Fax:231-228-5232
Practice Address - Street 1:9093 S. KASSON STREET
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MI
Practice Address - Zip Code:49621
Practice Address - Country:US
Practice Address - Phone:231-228-5233
Practice Address - Fax:231-228-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P31020Medicare PIN