Provider Demographics
NPI:1689784126
Name:BIG VISION, LLC
Entity Type:Organization
Organization Name:BIG VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DOUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-458-7141
Mailing Address - Street 1:1211 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3729
Mailing Address - Country:US
Mailing Address - Phone:517-990-0555
Mailing Address - Fax:517-990-0550
Practice Address - Street 1:1211 WARREN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3729
Practice Address - Country:US
Practice Address - Phone:517-990-0555
Practice Address - Fax:517-990-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D61058OtherBCBS
MI0N91130Medicare ID - Type Unspecified