Provider Demographics
NPI:1053522334
Name:MEADE FAMILY CHIROPRACTIC CENTER, PLC
Entity type:Organization
Organization Name:MEADE FAMILY CHIROPRACTIC CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOUBLE-MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-664-2555
Mailing Address - Street 1:802 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1331
Mailing Address - Country:US
Mailing Address - Phone:517-664-2555
Mailing Address - Fax:517-664-2596
Practice Address - Street 1:802 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1331
Practice Address - Country:US
Practice Address - Phone:517-664-2555
Practice Address - Fax:517-664-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N57560Medicare ID - Type Unspecified
MIU92568Medicare UPIN