Provider Demographics
NPI:1407021751
Name:DZIRBOWICZ CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:DZIRBOWICZ CHIROPRACTIC, PLC
Other - Org Name:ADA CHIROPRACTIC, PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DZIRBOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-676-2888
Mailing Address - Street 1:6739 FULTON ST E
Mailing Address - Street 2:SUITE C-20
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8138
Mailing Address - Country:US
Mailing Address - Phone:616-676-2888
Mailing Address - Fax:616-676-4299
Practice Address - Street 1:6739 FULTON ST E
Practice Address - Street 2:SUITE C-20
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8138
Practice Address - Country:US
Practice Address - Phone:616-676-2888
Practice Address - Fax:616-676-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMD008554OtherCOMMERCIAL INSURANCE
MI950D119010OtherBLUE CROSS BLUE SHIELD OF MICHIGAN TYPE II UPIN
MI950D119010OtherBLUE CROSS BLUE SHIELD OF MICHIGAN TYPE II UPIN