Provider Demographics
NPI:1841379104
Name:WESTRA CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:WESTRA CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WESTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-846-2330
Mailing Address - Street 1:124 W SAVIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-3101
Mailing Address - Country:US
Mailing Address - Phone:616-846-2330
Mailing Address - Fax:616-846-3283
Practice Address - Street 1:124 W SAVIDGE ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-3101
Practice Address - Country:US
Practice Address - Phone:616-846-2330
Practice Address - Fax:616-846-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1733668Medicaid
MI25911OtherPRIORITY HEALTH
MIT33500Medicare UPIN
MI1733668Medicaid