Provider Demographics
NPI:1700894367
Name:GRAND RIVER CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:GRAND RIVER CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-546-4888
Mailing Address - Street 1:3473 E. GRAND RIVER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-546-4888
Mailing Address - Fax:517-546-5003
Practice Address - Street 1:3473 E. GRAND RIVER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-546-4888
Practice Address - Fax:517-546-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D77609OtherBLUE CROSS BLUE SHIELD
MI3216874Medicaid
MI0M19020Medicare PIN