Provider Demographics
NPI:1992860084
Name:CHIROPRACTIC HEALTH CLINIC OF JONESVILLE
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CLINIC OF JONESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:STEVESON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:517-849-7230
Mailing Address - Street 1:107 OLDS ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1188
Mailing Address - Country:US
Mailing Address - Phone:517-849-7230
Mailing Address - Fax:517-849-7330
Practice Address - Street 1:107 OLDS ST
Practice Address - Street 2:SUITE 7
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1188
Practice Address - Country:US
Practice Address - Phone:517-849-7230
Practice Address - Fax:517-849-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB3986OtherMEDICARE RAILROAD
U93761Medicare UPIN
0N80020Medicare ID - Type Unspecified