Provider Demographics
NPI:1104327493
Name:MACK CHIROPRACTIC
Entity type:Organization
Organization Name:MACK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-748-7799
Mailing Address - Street 1:5160 RIVES JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9453
Mailing Address - Country:US
Mailing Address - Phone:517-990-4163
Mailing Address - Fax:
Practice Address - Street 1:2901 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1805
Practice Address - Country:US
Practice Address - Phone:517-748-7799
Practice Address - Fax:833-300-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386034486OtherNPI