Provider Demographics
NPI:1417075425
Name:COLESTOCK, DENISE SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:SUE
Last Name:COLESTOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1730
Mailing Address - Country:US
Mailing Address - Phone:517-663-8825
Mailing Address - Fax:517-663-8805
Practice Address - Street 1:802 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1730
Practice Address - Country:US
Practice Address - Phone:517-663-8825
Practice Address - Fax:517-663-8805
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B350460OtherBCBSM PROVIDER ID#
MIU94182Medicare UPIN
MI0N66790Medicare PIN