Provider Demographics
NPI:1083790067
Name:COLEMAN, RAYMOND LEONARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEONARD
Last Name:COLEMAN
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 1:1000 COUNTRYLANE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849
Mailing Address - Country:US
Mailing Address - Phone:906-486-2000
Mailing Address - Fax:906-486-1298
Practice Address - Street 1:1000 COUNTRY LN
Practice Address - Street 2:SUITE 250
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3406
Practice Address - Country:US
Practice Address - Phone:906-486-2000
Practice Address - Fax:906-486-1298
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OE25007Medicare PIN