Provider Demographics
NPI:1275683948
Name:DOBSON CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:DOBSON CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-288-5351
Mailing Address - Street 1:102 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1158
Mailing Address - Country:US
Mailing Address - Phone:989-288-5351
Mailing Address - Fax:989-288-5254
Practice Address - Street 1:102 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1158
Practice Address - Country:US
Practice Address - Phone:989-288-5351
Practice Address - Fax:989-288-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-05-21
Deactivation Date:2007-12-12
Deactivation Code:
Reactivation Date:2008-05-21
Provider Licenses
StateLicense IDTaxonomies
MIGD004472111N00000X
MIGP007854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4837011Medicaid
MI4837011Medicaid
MIT33605Medicare UPIN