Provider Demographics
NPI:1366612533
Name:ANSPACH, CORRIE ELTON (DC, CCSP)
Entity type:Individual
Prefix:MR
First Name:CORRIE
Middle Name:ELTON
Last Name:ANSPACH
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9565
Mailing Address - Country:US
Mailing Address - Phone:906-786-8888
Mailing Address - Fax:906-786-8813
Practice Address - Street 1:2620 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-9565
Practice Address - Country:US
Practice Address - Phone:906-786-8888
Practice Address - Fax:906-786-8813
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB150140Medicare UPIN