Provider Demographics
NPI:1982802161
Name:MCFADDEN CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:MCFADDEN CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-547-0995
Mailing Address - Street 1:12900 US HIGHWAY 31 N
Mailing Address - Street 2:SUITE G H
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1530
Mailing Address - Country:US
Mailing Address - Phone:231-547-0995
Mailing Address - Fax:231-237-0791
Practice Address - Street 1:12900 US HIGHWAY 31 N
Practice Address - Street 2:SUITE G H
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1530
Practice Address - Country:US
Practice Address - Phone:231-547-0995
Practice Address - Fax:231-237-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P11660Medicare PIN
U82298Medicare UPIN