Provider Demographics
NPI:1003341066
Name:DEKRAKER CUSHMAN PC
Entity Type:Organization
Organization Name:DEKRAKER CUSHMAN PC
Other - Org Name:GREENVILLE CHIROPRACTIC CLINIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DEKRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-754-9172
Mailing Address - Street 1:710 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2054
Mailing Address - Country:US
Mailing Address - Phone:616-754-9172
Mailing Address - Fax:616-754-1067
Practice Address - Street 1:710 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2054
Practice Address - Country:US
Practice Address - Phone:616-754-9172
Practice Address - Fax:616-754-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty