Provider Demographics
NPI:1124270368
Name:INLINE SPINES CHIROPRACTIC
Entity type:Organization
Organization Name:INLINE SPINES CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WOODBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-926-1829
Mailing Address - Street 1:128 W WALLED LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3455
Mailing Address - Country:US
Mailing Address - Phone:248-926-1829
Mailing Address - Fax:248-926-1837
Practice Address - Street 1:128 W WALLED LAKE DR
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3455
Practice Address - Country:US
Practice Address - Phone:248-926-1829
Practice Address - Fax:248-926-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2012-02-14
Deactivation Date:2009-02-04
Deactivation Code:
Reactivation Date:2009-02-19
Provider Licenses
StateLicense IDTaxonomies
MI2301009136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBCBS PROVIDER IDOther950F375750