Provider Demographics
NPI:1689705410
Name:KLIDA, DAVID JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:KLIDA
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 1:19361 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3904
Mailing Address - Country:US
Mailing Address - Phone:586-778-2323
Mailing Address - Fax:
Practice Address - Street 1:19361 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3904
Practice Address - Country:US
Practice Address - Phone:586-778-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E011940OtherBLLUE CROSS GROUP NUMBER
MI950E011950OtherBLUE CROSS GROUP NUMBER
MI950E05185OtherBLUE CROSS IND. NUMBER
MI950E011940OtherBLLUE CROSS GROUP NUMBER
MIT33721Medicare UPIN