Provider Demographics
NPI:1588982979
Name:SUPERIOR CHIROPRACTIC ASSOCIATES PLLC
Entity type:Organization
Organization Name:SUPERIOR CHIROPRACTIC ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JINNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:906-482-2400
Mailing Address - Street 1:45070 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:CHASSEL
Mailing Address - State:MI
Mailing Address - Zip Code:49916
Mailing Address - Country:US
Mailing Address - Phone:906-482-2400
Mailing Address - Fax:906-482-3080
Practice Address - Street 1:45070 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:CHASSEL
Practice Address - State:MI
Practice Address - Zip Code:49916
Practice Address - Country:US
Practice Address - Phone:906-482-2400
Practice Address - Fax:906-482-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITR009412111N00000X
MIJS009414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty