Provider Demographics
NPI:1194788521
Name:SPARTAN FAMILY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:SPARTAN FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-381-9730
Mailing Address - Street 1:1719 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1803
Mailing Address - Country:US
Mailing Address - Phone:517-381-9730
Mailing Address - Fax:517-381-9735
Practice Address - Street 1:1719 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1803
Practice Address - Country:US
Practice Address - Phone:517-381-9730
Practice Address - Fax:517-381-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008073111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4400103OtherPHP PROVIDER ID#
MI0C35089OtherBCBS PROVIDER #
MI7703223OtherAETNA PROVIDER #
MI7703223OtherAETNA PROVIDER #
MI0C35089OtherBCBS PROVIDER #