Provider Demographics
NPI:1144240607
Name:BRIDGEVIEW CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:BRIDGEVIEW CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-468-6009
Mailing Address - Street 1:28438 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3013
Mailing Address - Country:US
Mailing Address - Phone:586-468-6009
Mailing Address - Fax:586-468-6070
Practice Address - Street 1:28438 S RIVER RD
Practice Address - Street 2:
Practice Address - City:HARRISON TWP
Practice Address - State:MI
Practice Address - Zip Code:48045-3013
Practice Address - Country:US
Practice Address - Phone:586-468-6009
Practice Address - Fax:586-468-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005685111N00000X
MI2301005636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2836937Medicaid
MIBCN P70112Medicare ID - Type Unspecified
MIOP27360Medicare ID - Type Unspecified
MI2836937Medicaid