Provider Demographics
NPI:1295066389
Name:NORTHWOODS FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:NORTHWOODS FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SCARLASSARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-265-9000
Mailing Address - Street 1:615 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-1321
Mailing Address - Country:US
Mailing Address - Phone:906-265-9000
Mailing Address - Fax:906-265-9009
Practice Address - Street 1:615 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1321
Practice Address - Country:US
Practice Address - Phone:906-265-9000
Practice Address - Fax:906-265-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty