Provider Demographics
NPI:1861404576
Name:ISAACOFF, IRA B (DC)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:B
Last Name:ISAACOFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 E BREASBOIS CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-9500
Mailing Address - Country:US
Mailing Address - Phone:989-832-9200
Mailing Address - Fax:
Practice Address - Street 1:955 E BREASBOIS CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-9500
Practice Address - Country:US
Practice Address - Phone:989-832-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007419111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4302716Medicaid
MIU02535Medicare UPIN
MI4302716Medicaid