Provider Demographics
NPI:1881297950
Name:LEGACY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:LEGACY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHEMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-965-1197
Mailing Address - Street 1:4064 ALPINE AVE NW
Mailing Address - Street 2:STE B
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321
Mailing Address - Country:US
Mailing Address - Phone:616-965-1197
Mailing Address - Fax:
Practice Address - Street 1:4064 ALPINE AVE NW
Practice Address - Street 2:STE B
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321
Practice Address - Country:US
Practice Address - Phone:616-965-1197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty