Provider Demographics
NPI:1356661383
Name:DUNHAM, NATHAN JEREMY (DC)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JEREMY
Last Name:DUNHAM
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 1:2120 GRAND RIVER ANX STE 100
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7390
Mailing Address - Country:US
Mailing Address - Phone:810-225-7191
Mailing Address - Fax:810-225-7192
Practice Address - Street 1:2120 GRAND RIVER ANX STE 100
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7390
Practice Address - Country:US
Practice Address - Phone:810-225-7191
Practice Address - Fax:810-225-7192
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00000000123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor