Provider Demographics
NPI:1811077464
Name:DUCHENE CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:DUCHENE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUCHENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-791-5555
Mailing Address - Street 1:19199 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2508
Mailing Address - Country:US
Mailing Address - Phone:586-791-5555
Mailing Address - Fax:586-791-5575
Practice Address - Street 1:19199 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2508
Practice Address - Country:US
Practice Address - Phone:586-791-5555
Practice Address - Fax:586-791-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJD005304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E021510OtherBLUE CROSS BLUE SHIELD
MI950E021510OtherBLUE CARE NETWORK HMO
MI950E021510OtherBLUE CROSS BLUE SHIELD
MIT33153Medicare UPIN