Provider Demographics
NPI:1336326156
Name:SIDNEY A. DISBROW, D.C., P.C.
Entity Type:Organization
Organization Name:SIDNEY A. DISBROW, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:ARDEN
Authorized Official - Last Name:DISBROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-842-4241
Mailing Address - Street 1:518 S BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1954
Mailing Address - Country:US
Mailing Address - Phone:616-842-4241
Mailing Address - Fax:616-842-6707
Practice Address - Street 1:518 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1954
Practice Address - Country:US
Practice Address - Phone:616-842-4241
Practice Address - Fax:616-842-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H25031Medicare PIN