Provider Demographics
NPI:1982889820
Name:ROCHESTER FAMILY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:ROCHESTER FAMILY CHIROPRACTIC, INC
Other - Org Name:LAURA C NICHOLSON DC PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-373-2225
Mailing Address - Street 1:2909 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1419
Mailing Address - Country:US
Mailing Address - Phone:248-373-2225
Mailing Address - Fax:
Practice Address - Street 1:2909 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1419
Practice Address - Country:US
Practice Address - Phone:248-373-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty