Provider Demographics
NPI:1154435972
Name:CENTRAL MICHIGAN FAMILY CHIROPRACTIC CLINIC PLC
Entity type:Organization
Organization Name:CENTRAL MICHIGAN FAMILY CHIROPRACTIC CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-779-2225
Mailing Address - Street 1:1112 E BROOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1112 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-779-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty