Provider Demographics
NPI:1881920718
Name:PRO CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:PRO CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HLLENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-284-9072
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0220
Mailing Address - Country:US
Mailing Address - Phone:480-284-9072
Mailing Address - Fax:
Practice Address - Street 1:536 N OLD WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5375
Practice Address - Country:US
Practice Address - Phone:248-792-9736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1518967298OtherBCBS
MI95-0-F3-2959-0OtherBCBS