Provider Demographics
NPI:1376901389
Name:DAVID D BRELINSKI III, PLLC
Entity Type:Organization
Organization Name:DAVID D BRELINSKI III, PLLC
Other - Org Name:GRAND RAPIDS SPINE & SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BRELINSKI
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:248-895-6891
Mailing Address - Street 1:6079 E W AVE
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-9557
Mailing Address - Country:US
Mailing Address - Phone:248-895-6891
Mailing Address - Fax:
Practice Address - Street 1:130 MARKET AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4041
Practice Address - Country:US
Practice Address - Phone:248-895-6891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty