Healthcare Provider Details

I. General information

NPI: 1376901389
Provider Name (Legal Business Name): DAVID D BRELINSKI III, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MARKET AVE SW
GRAND RAPIDS MI
49503-4041
US

IV. Provider business mailing address

6079 E W AVE
VICKSBURG MI
49097-9557
US

V. Phone/Fax

Practice location:
  • Phone: 248-895-6891
  • Fax:
Mailing address:
  • Phone: 248-895-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010385
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID DALE BRELINSKI III
Title or Position: PRESIDENT
Credential: D.C.
Phone: 248-895-6891