Provider Demographics
NPI:1164976536
Name:DEHAVEN, DORIAN (DC)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:DEHAVEN
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 1:446 RINEHART RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5242
Mailing Address - Country:US
Mailing Address - Phone:616-826-0381
Mailing Address - Fax:
Practice Address - Street 1:10990 CHICAGO DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-8100
Practice Address - Country:US
Practice Address - Phone:616-546-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-14648111N00000X
MI2301010481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor