Provider Demographics
NPI:1225171960
Name:STROM BAVERS, LUCILE M (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCILE
Middle Name:M
Last Name:STROM BAVERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LUCILE
Other - Middle Name:M
Other - Last Name:STROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:230 BACKUS ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1504
Mailing Address - Country:US
Mailing Address - Phone:231-627-6161
Mailing Address - Fax:231-627-2921
Practice Address - Street 1:230 BACKUS ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1504
Practice Address - Country:US
Practice Address - Phone:231-627-6161
Practice Address - Fax:231-627-2921
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS007551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP95208OtherBLUE CROSS GREAT LAKES NE
MI143482674Medicaid
MI950A660960OtherBLUE CROSS
MIM65700001Medicare Oscar/Certification
MI950A660960OtherBLUE CROSS