Provider Demographics
NPI:1386675957
Name:BAETENS, BRYAN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ALAN
Last Name:BAETENS
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 1:26000 HARPER AVENUE SUITE A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-774-7920
Mailing Address - Fax:586-774-8336
Practice Address - Street 1:26000 HARPER AVENUE SUITE A
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-774-7920
Practice Address - Fax:586-774-8336
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M09520001Medicare UPIN
T33700Medicare UPIN