Provider Demographics
NPI:1922318013
Name:DOUMA BACK & NECK PAIN RELIEF INC
Entity Type:Organization
Organization Name:DOUMA BACK & NECK PAIN RELIEF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-321-7733
Mailing Address - Street 1:8080 MOORSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4421
Mailing Address - Country:US
Mailing Address - Phone:269-321-7733
Mailing Address - Fax:
Practice Address - Street 1:8080 MOORSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4421
Practice Address - Country:US
Practice Address - Phone:269-321-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N22860Medicare PIN