Provider Demographics
NPI:1528005915
Name:BRAJAK CHIROPRACTIC CLINIC PLLC
Entity type:Organization
Organization Name:BRAJAK CHIROPRACTIC CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAJAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-494-9300
Mailing Address - Street 1:8023 GRAND RIVER RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9392
Mailing Address - Country:US
Mailing Address - Phone:810-494-9300
Mailing Address - Fax:810-494-9320
Practice Address - Street 1:8023 GRAND RIVER RD
Practice Address - Street 2:SUITE 600
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9392
Practice Address - Country:US
Practice Address - Phone:810-494-9300
Practice Address - Fax:810-494-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0007024587OtherAETNA PIN
MI0D71119OtherBLUE CROSS BLUE SHIELD PIN
MI0007024587OtherAETNA PIN