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Organization
VAN BUREN CHIROPRACTIC CLINIC, P.C.
Active
Organization
VAN BUREN CHIROPRACTIC CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND CHARLES TATTERSALL D.C. (OWNER)
(269) 657-7005
Entity
Organization
Contact information
Practice address
309 S KALAMAZOO ST, PAW PAW, MI 49079-1527
(269) 657-7005
(269) 657-7007
Mailing address
309 S KALAMAZOO ST, PAW PAW, MI 49079-1527
(269) 657-7005
(269) 657-7007
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301004320
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16123
MCARE PIN
MI
05
—
1935037
—
MI
01
—
2301004320
LICENSE NUMBER
MI
01
—
44-30051
IBA/PHP NUMBER
MI
01
—
950H05002
BCBS MICHIGAN
MI
01
—
P67311
BLUE CARE NETWORK PIN
MI
01
—
RT004320
BCBS PIN
MI
Enumeration date
07/29/2006
Last updated
08/22/2020
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