Provider Demographics
NPI:1063455251
Name:BRACKEN, THOMAS MICHAEL (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:BRACKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 US 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4618
Mailing Address - Country:US
Mailing Address - Phone:989-356-6321
Mailing Address - Fax:989-356-6331
Practice Address - Street 1:2568 US 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4618
Practice Address - Country:US
Practice Address - Phone:989-356-6321
Practice Address - Fax:989-356-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11272474OtherCAQH (UCD)
MI950Z 45007OtherBCBSM
MI1613740Medicaid
MI1613740Medicaid
MI950Z 45007OtherBCBSM