Provider Demographics
NPI:1982853495
Name:ELIZABETH BAISE-BERGERON, D.C., P.C.
Entity Type:Organization
Organization Name:ELIZABETH BAISE-BERGERON, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SOPHIA
Authorized Official - Last Name:BAISE-BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-943-8290
Mailing Address - Street 1:4214 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6630
Mailing Address - Country:US
Mailing Address - Phone:517-552-9336
Mailing Address - Fax:517-552-9360
Practice Address - Street 1:4214 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6630
Practice Address - Country:US
Practice Address - Phone:517-552-9336
Practice Address - Fax:517-552-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty