Provider Demographics
NPI:1154569358
Name:BRUCE K. SHERMAN, DC, PLLC
Entity type:Organization
Organization Name:BRUCE K. SHERMAN, DC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-245-1111
Mailing Address - Street 1:1112 S LAPEER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3042
Mailing Address - Country:US
Mailing Address - Phone:810-245-1111
Mailing Address - Fax:810-245-8750
Practice Address - Street 1:1112 S LAPEER RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3042
Practice Address - Country:US
Practice Address - Phone:810-245-1111
Practice Address - Fax:810-245-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D410370OtherBCBS
MI=========OtherCOMMERCIAL
MI950D410370OtherBCBS
MI=========OtherCOMMERCIAL