Provider Demographics
NPI:1457394678
Name:LEVERENZ FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LEVERENZ FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVERENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-985-0084
Mailing Address - Street 1:2915 LAPEER AVE.
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3120
Mailing Address - Country:US
Mailing Address - Phone:810-985-0084
Mailing Address - Fax:810-984-3961
Practice Address - Street 1:2915 LAPEER AVE.
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3120
Practice Address - Country:US
Practice Address - Phone:810-985-0084
Practice Address - Fax:810-984-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301008500OtherMI LIC
MI2301008628OtherMI LIC
MI4410052Medicaid
MI2301008500OtherMI LIC
MI0N44760Medicare ID - Type Unspecified