Provider Demographics
NPI:1154985950
Name:BIGELOW, JEREMY DOUGLAS (BS DC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DOUGLAS
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:BS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 SHATTUCK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3287
Mailing Address - Country:US
Mailing Address - Phone:989-793-7791
Mailing Address - Fax:
Practice Address - Street 1:3350 SHATTUCK RD STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3287
Practice Address - Country:US
Practice Address - Phone:989-793-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor