Provider Demographics
NPI:1760713515
Name:BAY CHIROPRACTIC AND MASSAGE
Entity Type:Organization
Organization Name:BAY CHIROPRACTIC AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-649-4889
Mailing Address - Street 1:515 BAY ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2283
Mailing Address - Country:US
Mailing Address - Phone:231-421-5477
Mailing Address - Fax:231-421-5478
Practice Address - Street 1:515 BAY ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2283
Practice Address - Country:US
Practice Address - Phone:231-421-5477
Practice Address - Fax:231-421-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty