Organization
BAISE-BERGERON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH SOPHIA BAISE-BERGERON D.C. (OWNER)
(248) 943-8290
Entity
Organization
Contact information
Practice address
1365 S MAIN ST, SUITE B, PLYMOUTH, MI 48170-2217
(734) 927-4411
(734) 927-4410
Mailing address
1365 S MAIN ST, SUITE B, PLYMOUTH, MI 48170-2217
(734) 927-4411
(734) 927-4410
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008419
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950H215320
BLUE CROSS
MI
Enumeration date
07/09/2014
Last updated
07/09/2014
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