Provider Demographics
NPI:1477605350
Name:PAQUIN, THEODORE JAMES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JAMES
Last Name:PAQUIN
Suffix:JR
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 1:144 S INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9493
Mailing Address - Country:US
Mailing Address - Phone:734-944-8484
Mailing Address - Fax:
Practice Address - Street 1:144 S INDUSTRIAL DR.
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176
Practice Address - Country:US
Practice Address - Phone:734-944-8484
Practice Address - Fax:734-944-8686
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITP007301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MITP007301OtherSTATE LICENCE NUMBER
MIN90410003OtherCOMMON PROVIDER CODE
MI95-0H11245-0OtherBLUE CROSS BLUE SHIELD ID
MIP104674OtherBLUE CARE NETWORK #
MIN90410003OtherCOMMON PROVIDER CODE
MI383695055OtherEIN
MIU65969Medicare UPIN