Provider Demographics
NPI:1063571719
Name:ALPHA CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:ALPHA CHIROPRACTIC CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BUGAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-386-3838
Mailing Address - Street 1:1424 N MCEWAN STREET
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617
Mailing Address - Country:US
Mailing Address - Phone:989-386-3838
Mailing Address - Fax:989-386-2158
Practice Address - Street 1:1424 N MCEWAN STREET
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617
Practice Address - Country:US
Practice Address - Phone:989-386-3838
Practice Address - Fax:989-386-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4276447Medicaid
950A81015OtherB CROSS
MI0A85007Medicare PIN
MI4276447Medicaid