Provider Demographics
NPI:1649344086
Name:HARBOR FRONT FAMILY CHIROPRACTORS
Entity type:Organization
Organization Name:HARBOR FRONT FAMILY CHIROPRACTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROLF
Authorized Official - Last Name:TOELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-845-7800
Mailing Address - Street 1:300 S RATH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-3003
Mailing Address - Country:US
Mailing Address - Phone:213-845-7800
Mailing Address - Fax:231-845-7885
Practice Address - Street 1:300 S RATH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-3003
Practice Address - Country:US
Practice Address - Phone:213-845-7800
Practice Address - Fax:231-845-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherPPOM
MI=========OtherPPOM