Healthcare Provider Details

I. General information

NPI: 1982903696
Provider Name (Legal Business Name): DOUBLEDAY'S SPINE & BRAIN OF SOUTHWEST MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SOUTH SHORE DRIVE SUITE 121
BATTLE CREEK MI
49014
US

IV. Provider business mailing address

601 S SHORE DR SUITE 121
BATTLE CREEK MI
49014-5440
US

V. Phone/Fax

Practice location:
  • Phone: 269-963-3072
  • Fax: 269-963-3085
Mailing address:
  • Phone: 269-963-3072
  • Fax: 269-963-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2301009208
License Number StateMI

VIII. Authorized Official

Name: DR. BEAU DOUBLEDAY
Title or Position: MANAGER
Credential: D.C., D.A.C.N.B.
Phone: 269-963-3072