Provider Demographics
NPI:1154384949
Name:FAMILY FIRST CHIROPRACTIC PC
Entity type:Organization
Organization Name:FAMILY FIRST CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAYA
Authorized Official - Middle Name:DANIELE
Authorized Official - Last Name:NEWQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-275-1234
Mailing Address - Street 1:8618 GRAINERY RD SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8129
Mailing Address - Country:US
Mailing Address - Phone:616-275-1234
Mailing Address - Fax:616-275-1140
Practice Address - Street 1:10011 CROSSROAD CT SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7578
Practice Address - Country:US
Practice Address - Phone:616-275-1234
Practice Address - Fax:616-275-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P24220Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER