Provider Demographics
NPI:1154754554
Name:CHIROPRACTIC HEALTH CENTER, PC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:HUSBAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-291-1000
Mailing Address - Street 1:60930 US 31 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-5148
Mailing Address - Country:US
Mailing Address - Phone:574-291-1000
Mailing Address - Fax:
Practice Address - Street 1:60930 US 31 S
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-5148
Practice Address - Country:US
Practice Address - Phone:574-291-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000771A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty