Edmore Chiropractic Clinic, PLLC
Organization Active NPI Chiropractor · Edmore, MI
NPI 1124032040 · NPPES record last updated Jul 22, 2008
Key facts
- NPI
- 1124032040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2301006849 (MI)
- Legal business name
- EDMORE CHIROPRACTIC CLINIC, PLLC
- Practice address
- 215 W Howard City Edmore Rd
Edmore, MI 48829-9779 - Phone
- (989) 427-5551
- Fax
- (989) 427-3102
- NPI assigned
- Jul 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey Kenneth Lee, D.C.
- Title
- Owner/Operator
- Phone
- (989) 427-5551
Practitioners 1
-
Jeffrey Kenneth Lee, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080630000241 | MI | Part B Supplier - Clinic/Group Practice | 1254403637 |
Receives reassigned benefits from 1 practitioner Practice locations: Edmore, MI |
National Provider Directory
Locations
215 W Howard City Edmore Rd
Edmore, MI 48829
Phone (989) 427-5551
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 2301006849 | MI | Yes |
Addresses
Primary practice location
215 W Howard City Edmore Rd
Edmore, MI 48829-9779
Mailing address
215 W Howard City Edmore Rd
Edmore, MI 48829-9779
Phone (989) 427-5551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0E95013 | Other | MI | BLUE CROSS PROVIDER I.D. |
Other providers in Edmore, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.