Provider Demographics
NPI:1538239371
Name:BAISE-BERGERON, ELIZABETH SOPHIA (DC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SOPHIA
Last Name:BAISE-BERGERON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SOPHIA
Other - Last Name:BAISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:42171 ANN ARBOR RD E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4370
Mailing Address - Country:US
Mailing Address - Phone:734-927-4111
Mailing Address - Fax:734-927-4410
Practice Address - Street 1:42171 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4370
Practice Address - Country:US
Practice Address - Phone:734-927-4111
Practice Address - Fax:734-927-4410
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H215320OtherBCBS
MI950H215320OtherBCBS