Provider Demographics
NPI:1932120169
Name:SERVEN, BRUCE DEVERE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DEVERE
Last Name:SERVEN
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:G4010 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3518
Mailing Address - Country:US
Mailing Address - Phone:810-732-2210
Mailing Address - Fax:810-230-0158
Practice Address - Street 1:G4010 W COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3518
Practice Address - Country:US
Practice Address - Phone:810-732-2210
Practice Address - Fax:810-230-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005078111N00000X, 111NS0005X
MOCE5136111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2590087Medicaid
MI0B55005Medicare ID - Type Unspecified
MI2590087Medicaid