Provider Demographics
NPI:1942478847
Name:MINTZ FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:MINTZ FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-737-9494
Mailing Address - Street 1:5600 W MAPLE RD
Mailing Address - Street 2:SUITE A110
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3704
Mailing Address - Country:US
Mailing Address - Phone:248-737-9494
Mailing Address - Fax:248-865-2549
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:SUITE A110
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-737-9494
Practice Address - Fax:248-865-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEM007699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35461OtherBCBSM PIN
MIU77164Medicare UPIN
MI0P04710Medicare PIN