Provider Demographics
NPI:1265733513
Name:NICOLE BITTNER DC PC
Entity type:Organization
Organization Name:NICOLE BITTNER DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-494-1900
Mailing Address - Street 1:10192 GRAND RIVER RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6597
Mailing Address - Country:US
Mailing Address - Phone:810-494-1900
Mailing Address - Fax:810-494-1901
Practice Address - Street 1:10192 GRAND RIVER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6597
Practice Address - Country:US
Practice Address - Phone:810-494-1900
Practice Address - Fax:810-494-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty