Provider Demographics
NPI:1710173976
Name:DCDRS ENTERPRISES, INC.
Entity Type:Organization
Organization Name:DCDRS ENTERPRISES, INC.
Other - Org Name:DR. DAVE'S CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HAATAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-400-2090
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-0603
Mailing Address - Country:US
Mailing Address - Phone:989-400-2090
Mailing Address - Fax:
Practice Address - Street 1:201 E 17TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4173
Practice Address - Country:US
Practice Address - Phone:989-400-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A800220OtherBCBS GROUP PIN
MI0N88070OtherMEDICARE GROUP #
MIN88070001OtherMEDICARE INDIVIDUAL ID #
MI1710173976OtherGROUP NPI
MI1710173976OtherGROUP NPI