Provider Demographics
NPI:1063581619
Name:PASCHKET CHIROPRACTIC CLINIC P C
Entity type:Organization
Organization Name:PASCHKET CHIROPRACTIC CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PASCHKET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-659-2020
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-0328
Mailing Address - Country:US
Mailing Address - Phone:810-659-2020
Mailing Address - Fax:810-659-0310
Practice Address - Street 1:133 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1601
Practice Address - Country:US
Practice Address - Phone:810-659-2020
Practice Address - Fax:810-659-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP002974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B513060OtherBLUE CROSS BLUE SHIELD
MI950B513060OtherBLUE CROSS BLUE SHIELD
MIT32765Medicare UPIN