Organization
GREAT LAKES FAMILY CHIROPRACTIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS GENE MCKENZIE D.C. (DR. OWNER)
(616) 241-4040
Entity
Organization
Contact information
Practice address
3138 BROADMOOR AVE SE, KENTWOOD, MI 49512-1845
(616) 241-4040
(616) 475-6953
Mailing address
3138 BROADMOOR AVE SE, KENTWOOD, MI 49512-1845
(616) 241-4040
(616) 475-6953
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008451
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4754106
—
MI
Enumeration date
01/03/2006
Last updated
08/22/2020
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