Provider Demographics
NPI:1588739189
Name:SANFORD CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:SANFORD CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-687-7376
Mailing Address - Street 1:328 W SAGINAW RD
Mailing Address - Street 2:PO BOX 469
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9689
Mailing Address - Country:US
Mailing Address - Phone:989-687-7376
Mailing Address - Fax:989-687-9584
Practice Address - Street 1:328 W SAGINAW RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9689
Practice Address - Country:US
Practice Address - Phone:989-687-7376
Practice Address - Fax:989-687-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N71100Medicare ID - Type Unspecified