Provider Demographics
NPI:1699763417
Name:ACORN CHIROPRACTIC FAMILY HEALTH CLINIC INC PC
Entity type:Organization
Organization Name:ACORN CHIROPRACTIC FAMILY HEALTH CLINIC INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-945-5441
Mailing Address - Street 1:110 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1881
Mailing Address - Country:US
Mailing Address - Phone:269-945-5441
Mailing Address - Fax:269-945-8804
Practice Address - Street 1:110 W CENTER ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1881
Practice Address - Country:US
Practice Address - Phone:269-945-5441
Practice Address - Fax:269-945-8804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACORN CHIROPRACTIC FAMILY HEALTH CLINIC INC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-06
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDR0007688111N00000X
MIDR007605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M63090001Medicare ID - Type Unspecified
0M63090002Medicare ID - Type Unspecified