Provider Demographics
NPI:1871778340
Name:GREATER LANSING CHIROPRACTIC
Entity type:Organization
Organization Name:GREATER LANSING CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TRESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-268-6608
Mailing Address - Street 1:15694 S US 27
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-1486
Mailing Address - Country:US
Mailing Address - Phone:517-267-9888
Mailing Address - Fax:517-268-6609
Practice Address - Street 1:15694 S US 27
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-1486
Practice Address - Country:US
Practice Address - Phone:517-267-9888
Practice Address - Fax:517-268-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS005842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4705809Medicaid
MI0N35470Medicare PIN
MI4705809Medicaid