Provider Demographics
NPI:1700077898
Name:STRATTON CHIROPRACTIC CLINIC, P.L.L.C.
Entity Type:Organization
Organization Name:STRATTON CHIROPRACTIC CLINIC, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-375-2488
Mailing Address - Street 1:2555 S 11TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2174
Mailing Address - Country:US
Mailing Address - Phone:269-375-2488
Mailing Address - Fax:269-375-1788
Practice Address - Street 1:2555 S 11TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2174
Practice Address - Country:US
Practice Address - Phone:269-375-2488
Practice Address - Fax:269-375-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P52080Medicare PIN