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General NPI Number Information
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NPI Number | 1831534403
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Entity Type | Organization
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Legal Business Name | MIDLAND CHIROPRACTIC
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 4710 EASTMAN AVE
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City | MIDLAND
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State | MI
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Zip | 48640
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Country | US
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Telephone | 855-472-2279
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1824
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City | MIDLAND
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State | MI
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Zip | 48640
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Country | US
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Telephone | 855-472-2279
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. JEFFREY TUCKER BERARD
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Credential | DC
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Telephone | 772-359-8108
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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 | 2301010088
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License Number State | MI
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