Provider Demographics
NPI:1720116361
Name:BORDERTOWN CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BORDERTOWN CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCORNAIENCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-253-4000
Mailing Address - Street 1:2717 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3753
Mailing Address - Country:US
Mailing Address - Phone:906-253-4000
Mailing Address - Fax:
Practice Address - Street 1:2717 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3753
Practice Address - Country:US
Practice Address - Phone:906-253-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-A7-1019-0OtherBLUE CROSS & BLUE SHIELD
MI0N46710Medicare ID - Type Unspecified