Provider Demographics
NPI:1790299824
Name:BERNADETTE C. WEST, D.C., P.L.C.
Entity Type:Organization
Organization Name:BERNADETTE C. WEST, D.C., P.L.C.
Other - Org Name:BAYSIDE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-938-1710
Mailing Address - Street 1:4624 PAPER BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3828
Mailing Address - Country:US
Mailing Address - Phone:989-992-2101
Mailing Address - Fax:
Practice Address - Street 1:5168 US HIGHWAY 31 N STE 102
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9349
Practice Address - Country:US
Practice Address - Phone:231-938-1710
Practice Address - Fax:231-938-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty