Provider Demographics
NPI:1952570384
Name:EDWARD P HYBZA PC
Entity type:Organization
Organization Name:EDWARD P HYBZA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HYBZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-723-2221
Mailing Address - Street 1:50 FILER ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2726
Mailing Address - Country:US
Mailing Address - Phone:231-723-2221
Mailing Address - Fax:231-723-5078
Practice Address - Street 1:50 FILER ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2726
Practice Address - Country:US
Practice Address - Phone:231-723-2221
Practice Address - Fax:231-723-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E15002OtherBLUE CROSS BLUE SHIELD
MI350044192OtherRAIL ROAD MEDICARE
MI950E15002OtherBLUE CROSS BLUE SHIELD