Provider Demographics
NPI:1053594135
Name:ALLEN PARK FAMILY CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:ALLEN PARK FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JAMIE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-388-6099
Mailing Address - Street 1:8415 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1429
Mailing Address - Country:US
Mailing Address - Phone:313-388-6099
Mailing Address - Fax:313-388-8099
Practice Address - Street 1:8415 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1429
Practice Address - Country:US
Practice Address - Phone:313-388-6099
Practice Address - Fax:313-388-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H232820OtherBCBSM
MI950H232820OtherBCBSM
V06101Medicare UPIN