Provider Demographics
NPI:1720117880
Name:LAPEER CHIROPRACTIC CENTRE PC
Entity Type:Organization
Organization Name:LAPEER CHIROPRACTIC CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:OCHADLEUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-664-5310
Mailing Address - Street 1:498 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2427
Mailing Address - Country:US
Mailing Address - Phone:810-664-5310
Mailing Address - Fax:810-664-0221
Practice Address - Street 1:498 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2427
Practice Address - Country:US
Practice Address - Phone:810-664-5310
Practice Address - Fax:810-664-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3260193 TYPE 14Medicaid
MI950D450220OtherBLUE CARE NETWORK
MI950D450220OtherBLUE CROSS BLUE SHIELD
MICH 440004OtherMCARE
MI0980076OtherHEALTH PLUS
MI10369OtherGREAT LAKES
MICH 440004OtherMCARE