Provider Demographics
NPI:1952389736
Name:FAMILY CHIROPRACTIC & WELLNESS OF MIDLAND PLLC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC & WELLNESS OF MIDLAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KNOCHEL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:989-832-2349
Mailing Address - Street 1:2525 WASHINGTON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-4690
Mailing Address - Country:US
Mailing Address - Phone:989-832-2349
Mailing Address - Fax:989-259-1360
Practice Address - Street 1:2525 WASHINGTON ST
Practice Address - Street 2:STE 500
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-4600
Practice Address - Country:US
Practice Address - Phone:989-832-2349
Practice Address - Fax:989-832-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFK008865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4722443Medicaid
V01772Medicare UPIN
MI4722443Medicaid