Provider Demographics
NPI:1982903696
Name:DOUBLEDAY'S SPINE & BRAIN OF SOUTHWEST MICHIGAN PLLC
Entity Type:Organization
Organization Name:DOUBLEDAY'S SPINE & BRAIN OF SOUTHWEST MICHIGAN PLLC
Other - Org Name:DOUBLEDAY'S SPINE & BRAIN OF SOUTHWEST MICHIGAN PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUBLEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:269-963-3072
Mailing Address - Street 1:601 S SHORE DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5440
Mailing Address - Country:US
Mailing Address - Phone:269-963-3072
Mailing Address - Fax:269-963-3085
Practice Address - Street 1:601 SOUTH SHORE DRIVE
Practice Address - Street 2:SUITE 121
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014
Practice Address - Country:US
Practice Address - Phone:269-963-3072
Practice Address - Fax:269-963-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009208111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4878299Medicaid
MI950A210370OtherBLUE CROSS BLUE SHIELD
MI4878299Medicaid
MI950A210370OtherBLUE CROSS BLUE SHIELD