Provider Demographics
NPI:1366539504
Name:HOLISTIC CHIROPRACTIC CORP
Entity type:Organization
Organization Name:HOLISTIC CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBY
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-912-0075
Mailing Address - Street 1:18885 STONEWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8557
Mailing Address - Country:US
Mailing Address - Phone:248-912-0075
Mailing Address - Fax:
Practice Address - Street 1:670 GRISWOLD ST STE 200
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2687
Practice Address - Country:US
Practice Address - Phone:248-912-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H216160OtherBCBS PIN
MI142319OtherCARE CHOICES' PIN
MI950H216160OtherBCBS PIN
MIMI4423001Medicare PIN
MION82320Medicare PIN
MIMI4423Medicare PIN
MI142319OtherCARE CHOICES' PIN