Provider Demographics
NPI:1801911961
Name:CAPAC CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:CAPAC CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-395-2679
Mailing Address - Street 1:116 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CAPAC
Mailing Address - State:MI
Mailing Address - Zip Code:48014
Mailing Address - Country:US
Mailing Address - Phone:810-395-2679
Mailing Address - Fax:810-395-8809
Practice Address - Street 1:116 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CAPAC
Practice Address - State:MI
Practice Address - Zip Code:48014
Practice Address - Country:US
Practice Address - Phone:810-395-2679
Practice Address - Fax:810-395-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM68200Medicare ID - Type Unspecified