Provider Demographics
NPI:1831578285
Name:UNIVERSAL CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:UNIVERSAL CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.,E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:TY ALAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MCCUEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-639-2141
Mailing Address - Street 1:8 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MI
Mailing Address - Zip Code:49082-1186
Mailing Address - Country:US
Mailing Address - Phone:517-639-2141
Mailing Address - Fax:
Practice Address - Street 1:8 N MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MI
Practice Address - Zip Code:49082-1186
Practice Address - Country:US
Practice Address - Phone:517-639-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUINCY FAMILY CHIROPRACTIC, P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009454261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI 6762Medicare PIN