Provider Demographics
NPI:1285639187
Name:POOLE, CINDY LU (DC)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:LU
Last Name:POOLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 S ISABELLA RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-773-1816
Mailing Address - Fax:989-773-4926
Practice Address - Street 1:2705 S ISABELLA RD
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:989-773-1816
Practice Address - Fax:989-773-4926
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32921Medicare UPIN
MIOC75006Medicare ID - Type Unspecified