Provider Demographics
NPI:1679661607
Name:EASTON, WILLIAM CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:EASTON
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 1:8185 COOLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2306
Mailing Address - Country:US
Mailing Address - Phone:248-360-2800
Mailing Address - Fax:248-363-4054
Practice Address - Street 1:8185 COOLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2306
Practice Address - Country:US
Practice Address - Phone:248-360-2800
Practice Address - Fax:248-363-4054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWE005494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OF351710OtherBCBSM PROVIDER ID
MIY56789Medicare UPIN
MI95OF351710OtherBCBSM PROVIDER ID