Provider Demographics
NPI:1386728509
Name:DEWEESE CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:DEWEESE CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DEWEESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-247-1000
Mailing Address - Street 1:945 BURTON ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-1422
Mailing Address - Country:US
Mailing Address - Phone:616-247-1000
Mailing Address - Fax:616-247-0121
Practice Address - Street 1:945 BURTON ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-1422
Practice Address - Country:US
Practice Address - Phone:616-247-1000
Practice Address - Fax:616-247-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP67433OtherBLUE CARE NETWORK
MIP67433OtherBLUE CARE NETWORK