Provider Demographics
NPI:1063553097
Name:MESSAMORE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:MESSAMORE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MESSAMORE
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:269-978-4325
Mailing Address - Street 1:5053 SPORTS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7117
Mailing Address - Country:US
Mailing Address - Phone:269-978-4325
Mailing Address - Fax:269-978-1108
Practice Address - Street 1:5053 SPORTS DR
Practice Address - Street 2:STE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7117
Practice Address - Country:US
Practice Address - Phone:269-978-4325
Practice Address - Fax:269-978-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKM008130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0007351293OtherAETNA PIN
MIP110843OtherBCN NUMBER
MI0007351293OtherAETNA PIN
MIU81151Medicare UPIN