Provider Demographics
NPI:1245665595
Name:NORTHERN SPORTS AND FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:NORTHERN SPORTS AND FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LACOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-353-8010
Mailing Address - Street 1:13418 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9063
Mailing Address - Country:US
Mailing Address - Phone:906-353-8010
Mailing Address - Fax:906-353-8011
Practice Address - Street 1:13418 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9063
Practice Address - Country:US
Practice Address - Phone:906-353-8010
Practice Address - Fax:906-353-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty