Provider Demographics
NPI:1093011926
Name:SHARP CHIROPRACTIC OF MICHIGAN LLC
Entity type:Organization
Organization Name:SHARP CHIROPRACTIC OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-667-9700
Mailing Address - Street 1:3400 WILDER RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2331
Mailing Address - Country:US
Mailing Address - Phone:989-667-9700
Mailing Address - Fax:989-667-9701
Practice Address - Street 1:3400 WILDER RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2331
Practice Address - Country:US
Practice Address - Phone:989-667-9700
Practice Address - Fax:989-667-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS009686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty