Provider Demographics
NPI:1154548907
Name:AXIS CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:AXIS CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KULBIEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-226-3663
Mailing Address - Street 1:1300 W RIDGE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3194
Mailing Address - Country:US
Mailing Address - Phone:906-226-3663
Mailing Address - Fax:906-226-2956
Practice Address - Street 1:1300 W RIDGE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3194
Practice Address - Country:US
Practice Address - Phone:906-226-3663
Practice Address - Fax:906-226-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBK008347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDE5464Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP#
MI0P31050Medicare ID - Type UnspecifiedGROUP MEDICARE #