Provider Demographics
NPI:1780729798
Name:BYRNE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BYRNE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-866-6083
Mailing Address - Street 1:355 NORTHLAND DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1418
Mailing Address - Country:US
Mailing Address - Phone:616-866-6083
Mailing Address - Fax:616-863-9237
Practice Address - Street 1:355 NORTHLAND DR NE STE A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1418
Practice Address - Country:US
Practice Address - Phone:616-866-6083
Practice Address - Fax:616-863-9237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU86740Medicare UPIN