Provider Demographics
NPI:1114907342
Name:ISAACSON, DAVIN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVIN
Middle Name:ANDREW
Last Name:ISAACSON
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 1:101 E QUINCY ST
Mailing Address - Street 2:STE 3
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-2167
Mailing Address - Country:US
Mailing Address - Phone:906-482-4900
Mailing Address - Fax:906-482-0601
Practice Address - Street 1:101 E QUINCY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-2167
Practice Address - Country:US
Practice Address - Phone:906-482-4900
Practice Address - Fax:906-482-0601
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C110310OtherBCBS
OP40460Medicare PIN