Provider Demographics
NPI:1477607679
Name:BRYAN A. BAETENS, D.C., P.C.
Entity Type:Organization
Organization Name:BRYAN A. BAETENS, D.C., P.C.
Other - Org Name:BAETENS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAETENS, D.C., P.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-774-7920
Mailing Address - Street 1:26000 HARPER AVENUE
Mailing Address - Street 2:SUITE A
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
Practice Address - Street 2:SUITE A
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004667111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M09520Medicare ID - Type Unspecified