Provider Demographics
NPI:1093988453
Name:JOHN CHADWICK M.D. P.C.
Entity Type:Organization
Organization Name:JOHN CHADWICK M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-968-1654
Mailing Address - Street 1:203 CAPITAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3926
Mailing Address - Country:US
Mailing Address - Phone:269-968-1654
Mailing Address - Fax:269-968-0760
Practice Address - Street 1:203 CAPITAL AVE NE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3926
Practice Address - Country:US
Practice Address - Phone:269-968-1654
Practice Address - Fax:269-968-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI036575Medicaid
MIA75931Medicare UPIN