Provider Demographics
NPI:1730326885
Name:STAR CHIROPRACTIC LLC
Entity type:Organization
Organization Name:STAR CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MANDZIUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-207-1702
Mailing Address - Street 1:407 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1456
Mailing Address - Country:US
Mailing Address - Phone:586-207-1702
Mailing Address - Fax:
Practice Address - Street 1:407 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1456
Practice Address - Country:US
Practice Address - Phone:586-207-1702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009309261QM2500X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty