Provider Demographics
NPI:1528314200
Name:HUNGERFORD CHIROPRACTIC & WELLNESS CENTER PC
Entity type:Organization
Organization Name:HUNGERFORD CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUNGERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-377-9583
Mailing Address - Street 1:4172 LAKE MICHIGAN DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-4527
Mailing Address - Country:US
Mailing Address - Phone:616-419-4996
Mailing Address - Fax:616-419-4997
Practice Address - Street 1:4172 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-4527
Practice Address - Country:US
Practice Address - Phone:269-377-9583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598067589Medicaid
MIMI 3668Medicare PIN