Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2301010153 | MI |
N | 111NI0013X | Independent Medical Examiner | 2301010153 | MI |
NPI | 1053739060 |
---|---|
Provider Name | Breanna Cleasby |
First Address | Richland, MI 49083-8216 |
Second Address | Richland, MI 49083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 13/09/2018 |