Provider Demographics
NPI:1750593083
Name:BRUSVEEN CHIROPRACTIC, PLC
Entity type:Organization
Organization Name:BRUSVEEN CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUSVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-846-7300
Mailing Address - Street 1:17040 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2792
Mailing Address - Country:US
Mailing Address - Phone:616-846-7300
Mailing Address - Fax:616-846-2197
Practice Address - Street 1:17040 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2792
Practice Address - Country:US
Practice Address - Phone:616-846-7300
Practice Address - Fax:616-846-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G01412OtherBCBS PIN
MI0N62030Medicare Oscar/Certification
MI0G01412OtherBCBS PIN