Provider Demographics
NPI:1265788509
Name:THE CHIROPRACTIC DOCTORS PLLC
Entity type:Organization
Organization Name:THE CHIROPRACTIC DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PHINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-255-3956
Mailing Address - Street 1:5747 28TH STREET SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49549-4800
Mailing Address - Country:US
Mailing Address - Phone:616-432-3103
Mailing Address - Fax:616-328-6364
Practice Address - Street 1:5747 28TH STREET SE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49549-4800
Practice Address - Country:US
Practice Address - Phone:616-432-3103
Practice Address - Fax:616-328-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty