Provider Demographics
NPI:1306960828
Name:FIRSTEN, STUART ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:ALAN
Last Name:FIRSTEN
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:2480 W CAMPUS DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5414
Mailing Address - Country:US
Mailing Address - Phone:989-772-1609
Mailing Address - Fax:989-953-4949
Practice Address - Street 1:6079 W MAPLE RD
Practice Address - Street 2:#100B
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2283
Practice Address - Country:US
Practice Address - Phone:248-851-7246
Practice Address - Fax:248-851-7223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI2301005095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P13600Medicare PIN
MI0N95180Medicare PIN
MI0F35091Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER