Provider Demographics
NPI:1194788018
Name:DOLECKI, CHRISTOPHER ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:DOLECKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2102
Mailing Address - Country:US
Mailing Address - Phone:248-391-1040
Mailing Address - Fax:248-391-8927
Practice Address - Street 1:4110 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2102
Practice Address - Country:US
Practice Address - Phone:248-391-1040
Practice Address - Fax:248-391-8927
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1870424Medicaid
MI0F35255Medicare ID - Type Unspecified
MI1870424Medicaid