Provider Demographics
NPI:1538217203
Name:AFFORDABLE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:AFFORDABLE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:SKOUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-664-1111
Mailing Address - Street 1:911 BALDWIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3738
Mailing Address - Country:US
Mailing Address - Phone:810-664-1111
Mailing Address - Fax:810-664-7199
Practice Address - Street 1:911 BALDWIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3738
Practice Address - Country:US
Practice Address - Phone:810-664-1111
Practice Address - Fax:810-664-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4262675Medicaid
MI95-0-D4-5027OtherBLUE CROSS
MI4262675Medicaid
MION20980Medicare ID - Type Unspecified