Provider Demographics
NPI:1861886194
Name:KIRSHNER CHIROPRACTIC LIFE CENTER
Entity type:Organization
Organization Name:KIRSHNER CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIRSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-482-7700
Mailing Address - Street 1:1412 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5985
Mailing Address - Country:US
Mailing Address - Phone:734-482-7700
Mailing Address - Fax:
Practice Address - Street 1:1412 ECORSE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5985
Practice Address - Country:US
Practice Address - Phone:734-482-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H11278OtherBCBS PROVIDER #
MI2117586 TYPE #14Medicaid
0H15061OtherWPS PROVIDER #