MEDICARE: DUCHENE CHIROPRACTIC, P.C.

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
1	111N00000X	Chiropractor	JD005304	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950E021510	OTHER	MI	BLUE CROSS BLUE SHIELD
2	950E021510	OTHER	MI	BLUE CARE NETWORK HMO

General Provider Information

NPI Number	:	1811077464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUCHENE CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	19199 15 MILE RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-2508
Country	:	US
Telephone Number	:	586-791-5555
Fax Number	:	586-791-5575

Provider Business Practice Location Address
First Line	:	19199 15 MILE RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-2508
Country	:	US
Telephone Number	:	586-791-5555
Fax Number	:	586-791-5575

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY CHARLES DUCHENE
Credential	:	D.C.
Telephone Number	:	586-791-5555

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/04/2008

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