Provider Demographics
NPI:1164627709
Name:ONAWAY CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:ONAWAY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES DC
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-733-2800
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:20417 E STATE ST
Mailing Address - City:ONAWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49765
Mailing Address - Country:US
Mailing Address - Phone:989-733-2800
Mailing Address - Fax:989-733-7571
Practice Address - Street 1:20417 E STATE ST
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765
Practice Address - Country:US
Practice Address - Phone:989-733-2800
Practice Address - Fax:989-733-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005624111N00000X
MI2301005890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3355232Medicaid
MIP82400OtherBCN DOUG
MI4384800Medicaid
MIP10Y066OtherBCN SHELLEY
MIS15009Medicare UPIN
MI0G15008Medicare ID - Type UnspecifiedDOUG
MIP82400OtherBCN DOUG
MI3355232Medicaid