Healthcare Provider Details

I. General information

NPI: 1437407988
Provider Name (Legal Business Name): BAYSIDE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 ELIZABETH ST
SAUGATUCK MI
49453-9736
US

IV. Provider business mailing address

3413 ELIZABETH ST
SAUGATUCK MI
49453-9736
US

V. Phone/Fax

Practice location:
  • Phone: 269-857-5105
  • Fax:
Mailing address:
  • Phone: 269-857-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301006039
License Number StateMI

VIII. Authorized Official

Name: ERIC KEES PEET
Title or Position: SOLE PROPRIETOR
Credential: D.C.
Phone: 269-857-5105