Provider Demographics
NPI:1770576928
Name:DORAIS, BRUCE J (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:DORAIS
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 1:912 CAPITAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-5608
Mailing Address - Country:US
Mailing Address - Phone:269-968-4216
Mailing Address - Fax:269-968-3160
Practice Address - Street 1:912 CAPITAL AVE NE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-5608
Practice Address - Country:US
Practice Address - Phone:269-968-4216
Practice Address - Fax:269-968-3160
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOA31122OtherBC
MI2099352Medicaid
MIOA31122OtherBC
OA35036Medicare ID - Type Unspecified