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NPI Code Detail

MEDICARE: DEKRAKER CUSHMAN PC

MEDICARE: DEKRAKER CUSHMAN PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor

General Provider Information

NPI Number : 1003341066
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEKRAKER CUSHMAN PC
Provider Business Mailing Address
First Line : 710 E WASHINGTON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2054
Country : US
Telephone Number : 616-754-9172
Fax Number : 616-754-1067
Provider Business Practice Location Address
First Line : 710 E WASHINGTON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2054
Country : US
Telephone Number : 616-754-9172
Fax Number : 616-754-1067
Authorized Official
Title or Position : PRESIDENT
Name : DR. MATTHEW PETER DEKRAKER
Credential : DC
Telephone Number : 616-754-9172
Provider Enumeration Date : 04/27/2017
Last Update Date : 04/27/2017

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Directions to “DEKRAKER CUSHMAN PC ” Practice Location

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