Provider Demographics
NPI:1548457567
Name:R&E CLINIC P.C.
Entity type:Organization
Organization Name:R&E CLINIC P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BEND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-385-0235
Mailing Address - Street 1:4040 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3800
Mailing Address - Country:US
Mailing Address - Phone:810-385-0235
Mailing Address - Fax:
Practice Address - Street 1:4040 24TH AVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3800
Practice Address - Country:US
Practice Address - Phone:810-385-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB002571111N00000X
MI2301008618111N00000X
MIRB008935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6257530001Medicare NSC