Provider Demographics
NPI:1114045721
Name:OKEMOS FAMILY CHIROPRACTIC INC
Entity type:Organization
Organization Name:OKEMOS FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PERRAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-381-1880
Mailing Address - Street 1:2199 JOLLY RD
Mailing Address - Street 2:140
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3968
Mailing Address - Country:US
Mailing Address - Phone:517-381-1880
Mailing Address - Fax:517-381-1990
Practice Address - Street 1:2199 JOLLY RD STE 140
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3968
Practice Address - Country:US
Practice Address - Phone:517-381-1880
Practice Address - Fax:517-381-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N56140OtherPTAN
MI0N56140Medicare ID - Type Unspecified