Provider Demographics
NPI:1154716116
Name:NATHAN J. DUNHAM, D.C., P.L.L.C.
Entity type:Organization
Organization Name:NATHAN J. DUNHAM, D.C., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-574-4291
Mailing Address - Street 1:3400 PINETREE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4286
Mailing Address - Country:US
Mailing Address - Phone:517-574-4291
Mailing Address - Fax:
Practice Address - Street 1:3400 PINETREE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4286
Practice Address - Country:US
Practice Address - Phone:517-574-4291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4504001Medicare UPIN