Provider Demographics
NPI:1568648145
Name:APPLIED KINESIOLOGY INSTITUTE
Entity type:Organization
Organization Name:APPLIED KINESIOLOGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOFFEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-780-4045
Mailing Address - Street 1:203 S WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2011
Mailing Address - Country:US
Mailing Address - Phone:517-780-4045
Mailing Address - Fax:
Practice Address - Street 1:203 S WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2011
Practice Address - Country:US
Practice Address - Phone:517-780-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK007516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M58280Medicare PIN