Provider Demographics
NPI:1548487168
Name:BRIDGMAN CHIROPRACTORS. P.C.
Entity type:Organization
Organization Name:BRIDGMAN CHIROPRACTORS. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-465-6757
Mailing Address - Street 1:9500 RED ARROW HWY.
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-0326
Mailing Address - Country:US
Mailing Address - Phone:269-465-6757
Mailing Address - Fax:269-466-5202
Practice Address - Street 1:9500 RED ARROW HWY.
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-0326
Practice Address - Country:US
Practice Address - Phone:269-465-6757
Practice Address - Fax:269-466-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P53220Medicare PIN