Provider Demographics
NPI:1679813067
Name:JMSII CHIROPRACTIC PC
Entity type:Organization
Organization Name:JMSII CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:906-387-1200
Mailing Address - Street 1:126 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1122
Mailing Address - Country:US
Mailing Address - Phone:906-387-1200
Mailing Address - Fax:
Practice Address - Street 1:126 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1122
Practice Address - Country:US
Practice Address - Phone:906-387-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1336407675OtherNPPES