Provider Demographics
NPI:1053626499
Name:TILTON CHIROPRACTIC PC
Entity type:Organization
Organization Name:TILTON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:TILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-949-1888
Mailing Address - Street 1:1593 GALBRAITH SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7140
Mailing Address - Country:US
Mailing Address - Phone:616-949-1888
Mailing Address - Fax:616-949-9602
Practice Address - Street 1:1593 GALBRAITH SE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7140
Practice Address - Country:US
Practice Address - Phone:616-949-1888
Practice Address - Fax:616-949-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNON93790Medicare PIN