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General NPI Number Information
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NPI Number | 1437407988
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Entity Type | Organization
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Legal Business Name | BAYSIDE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 3413 ELIZABETH ST
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City | SAUGATUCK
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State | MI
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Zip | 49453-9736
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Country | US
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Telephone | 269-857-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 ELIZABETH ST
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City | SAUGATUCK
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State | MI
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Zip | 49453-9736
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Country | US
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Telephone | 269-857-5105
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ERIC KEES PEET
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Credential | D.C.
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Telephone | 269-857-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301006039
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License Number State | MI
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