Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2301009208 | MI |
Y | 111NN0400X | Neurology | 2301009208 | MI |
NPI | 1972604031 |
---|---|
Provider Name | Dr. Beau Dustin Doubleday |
First Address | Battle Creek, MI 49014-5440 |
Second Address | Battle Creek, MI 49014-5440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4978299 | (05) | MI |
V10989 | (02) | MI |