Provider Demographics
NPI:1770628349
Name:TROMBLY, ANTHONY EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:TROMBLY
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 1:2230 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9504
Mailing Address - Country:US
Mailing Address - Phone:616-987-4445
Mailing Address - Fax:616-987-4440
Practice Address - Street 1:2230 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9504
Practice Address - Country:US
Practice Address - Phone:616-987-4445
Practice Address - Fax:616-987-4440
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D150750OtherBLUE CROSS & BLUE SHEILD
MI4304102Medicaid
MI4304102Medicaid