Provider Demographics
NPI:1326058520
Name:BILYEA, BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BILYEA
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 1:2170 S MOREY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-9013
Mailing Address - Country:US
Mailing Address - Phone:231-839-4263
Mailing Address - Fax:231-839-4264
Practice Address - Street 1:2170 S MOREY RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-9013
Practice Address - Country:US
Practice Address - Phone:231-839-4263
Practice Address - Fax:231-839-4264
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E710040OtherBLUE CROSS BLUE SHIELD
MI4432434-14Medicaid
MI950E710040OtherBLUE CROSS BLUE SHIELD
MI0P20000001Medicare PIN