Provider Demographics
NPI:1750641932
Name:BRIDGE CHIROPRACTIC AND INTEGRATED HEALTH LLC
Entity Type:Organization
Organization Name:BRIDGE CHIROPRACTIC AND INTEGRATED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCPHARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-650-1842
Mailing Address - Street 1:1025 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3763
Mailing Address - Country:US
Mailing Address - Phone:810-294-5678
Mailing Address - Fax:810-294-5677
Practice Address - Street 1:1025 HURON AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3763
Practice Address - Country:US
Practice Address - Phone:810-294-5678
Practice Address - Fax:810-294-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009785111N00000X
MI2301008972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty