Provider Demographics
NPI:1235390162
Name:DR BRUCE D SERVEN PC
Entity Type:Organization
Organization Name:DR BRUCE D SERVEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DEVERE
Authorized Official - Last Name:SERVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-732-2210
Mailing Address - Street 1:G4010 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3518
Mailing Address - Country:US
Mailing Address - Phone:810-732-2210
Mailing Address - Fax:810-230-0158
Practice Address - Street 1:G4010 W COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3518
Practice Address - Country:US
Practice Address - Phone:810-732-2210
Practice Address - Fax:810-230-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005078111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0981838OtherHEALTHPLUS OF MICHIGAN
MI2590087Medicaid
MI950B55005OtherBCBSM
MI2590087Medicaid