Provider Demographics
NPI:1861447468
Name:MAILLETTE, ERIC JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHN
Last Name:MAILLETTE
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 1:3916 TRAXLER CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9612
Mailing Address - Country:US
Mailing Address - Phone:989-667-9700
Mailing Address - Fax:989-667-9701
Practice Address - Street 1:3916 TRAXLER CT
Practice Address - Street 2:SUITE A
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9612
Practice Address - Country:US
Practice Address - Phone:989-667-9700
Practice Address - Fax:989-667-9701
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEM007459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU70620Medicare UPIN
MION94500001Medicare ID - Type Unspecified