Provider Demographics
NPI:1831233931
Name:THUNDER BAY CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:THUNDER BAY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:CHURA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-356-4126
Mailing Address - Street 1:2568 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4618
Mailing Address - Country:US
Mailing Address - Phone:989-356-4126
Mailing Address - Fax:989-356-6331
Practice Address - Street 1:2477 US HIGHWAY 23 S STE C
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4610
Practice Address - Country:US
Practice Address - Phone:989-356-4126
Practice Address - Fax:989-354-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950Z41012OtherBLUE CROSS GROUP CODE
MI0M88930Medicare ID - Type UnspecifiedMEDICARE GROUP CODE