Provider Demographics
NPI:1730144643
Name:ZAPOR, BRUCE STANLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STANLEY
Last Name:ZAPOR
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 1:10415 GRAND RIVER RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6533
Mailing Address - Country:US
Mailing Address - Phone:810-229-1944
Mailing Address - Fax:810-229-6955
Practice Address - Street 1:10415 GRAND RIVER RD
Practice Address - Street 2:SUITE 450
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6533
Practice Address - Country:US
Practice Address - Phone:810-229-1944
Practice Address - Fax:810-229-6955
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBZ006499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33094Medicare UPIN
MIOD750048952Medicare ID - Type Unspecified