Provider Demographics
NPI:1558670745
Name:CALKINS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CALKINS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:CALKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-241-4018
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-0247
Mailing Address - Country:US
Mailing Address - Phone:734-241-4018
Mailing Address - Fax:734-241-4023
Practice Address - Street 1:15581 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3954
Practice Address - Country:US
Practice Address - Phone:734-243-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008915111N00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4771Medicare PIN