Provider Demographics
NPI:1437170883
Name:REEGEN, FRANKLIN MARK (DC)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:MARK
Last Name:REEGEN
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 1:27701 WOODWARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072
Mailing Address - Country:US
Mailing Address - Phone:248-544-0000
Mailing Address - Fax:
Practice Address - Street 1:27701 WOODWARD AVENUE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072
Practice Address - Country:US
Practice Address - Phone:248-544-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588450Medicaid
MI0F35074Medicare ID - Type Unspecified
U36779Medicare UPIN