Provider Demographics
NPI:1174711105
Name:BORCK FAMILY CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:BORCK FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BORCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-448-2277
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-0047
Mailing Address - Country:US
Mailing Address - Phone:517-448-2277
Mailing Address - Fax:517-448-2288
Practice Address - Street 1:227 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-1001
Practice Address - Country:US
Practice Address - Phone:517-448-2277
Practice Address - Fax:517-448-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008759305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN91720Medicare PIN