Provider Demographics
NPI:1366561805
Name:FAMILY CHIROPRACTIC CLINICS OF MICHIGAN, P.C.
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CLINICS OF MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-302-7000
Mailing Address - Street 1:250 W EISENHOWER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6948
Mailing Address - Country:US
Mailing Address - Phone:734-302-7000
Mailing Address - Fax:734-302-7001
Practice Address - Street 1:250 W EISENHOWER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6948
Practice Address - Country:US
Practice Address - Phone:734-302-7000
Practice Address - Fax:734-302-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N90410Medicare PIN