Provider Demographics
NPI:1164689097
Name:CHIROPRACTIC CENTER OF BATTLE CREEK
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF BATTLE CREEK
Other - Org Name:CHIROPRACTIC CENTER OF HOBBS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-968-2060
Mailing Address - Street 1:395 S SHORE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5466
Mailing Address - Country:US
Mailing Address - Phone:269-968-2060
Mailing Address - Fax:
Practice Address - Street 1:395 S SHORE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5466
Practice Address - Country:US
Practice Address - Phone:269-968-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0007838033OtherAETNA
MIP74060OtherBLUE CARE NETWORK
MI3465468Medicaid
MI350043131OtherMEDICARE RAIL ROAD
MI950A350030OtherBLUE CROSS BLUE SHIELD
MIT41060Medicare UPIN