Provider Demographics
NPI:1962679019
Name:ESSENTIAL CHIROPRACTIC SERVICES INC
Entity Type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-547-5093
Mailing Address - Street 1:23158 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1341
Mailing Address - Country:US
Mailing Address - Phone:248-547-5093
Mailing Address - Fax:248-547-1829
Practice Address - Street 1:23158 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1341
Practice Address - Country:US
Practice Address - Phone:248-547-5093
Practice Address - Fax:248-547-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB006851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F352320OtherBCBSM PIN
MIBB006851OtherLISCENSE
MIT97311Medicare UPIN
MI0F35232Medicare PIN