Healthcare Provider Details

I. General information

NPI: 1750119947
Provider Name (Legal Business Name): DOUGLAS CHIDESTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 W ST JOE HWY STE 6
LANSING MI
48917-6004
US

IV. Provider business mailing address

5021 W ST JOE HWY STE 6
LANSING MI
48917-6004
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-5243
  • Fax:
Mailing address:
  • Phone: 517-321-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: