Provider Demographics
NPI:1215071188
Name:DCC PC
Entity type:Organization
Organization Name:DCC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-543-2920
Mailing Address - Street 1:432 N COCHRAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1126
Mailing Address - Country:US
Mailing Address - Phone:517-543-2920
Mailing Address - Fax:517-543-1221
Practice Address - Street 1:432 N COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1126
Practice Address - Country:US
Practice Address - Phone:517-543-2920
Practice Address - Fax:517-543-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B311390OtherBLUE CARE NETWORK
MI1024457OtherMCLAREN
MI200000008883OtherPHPMM
MI5198793Medicaid
DG8562OtherMEDICARE RAILROAD
MI950B311390OtherBLUE CROSS BLUE SHIELD
MI5198793Medicaid
MI200000008883OtherPHPMM