Healthcare Provider Details

I. General information

NPI: 1780414573
Provider Name (Legal Business Name): COLE JASON BASKERVILLE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W CHISHOLM ST
ALPENA MI
49707-2446
US

IV. Provider business mailing address

114 W CHISHOLM ST
ALPENA MI
49707-2446
US

V. Phone/Fax

Practice location:
  • Phone: 989-884-1212
  • Fax:
Mailing address:
  • Phone: 989-884-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: