Provider Demographics
NPI:1447312921
Name:SHERMAN, BRUCE KELVIN (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:KELVIN
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 HIDDEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-9325
Mailing Address - Country:US
Mailing Address - Phone:810-245-1111
Mailing Address - Fax:810-664-0138
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3077
Practice Address - Country:US
Practice Address - Phone:810-245-1111
Practice Address - Fax:810-664-0138
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002868111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP33622FMedicare UPIN
MI1012591Medicare UPIN
MI0P07580Medicare ID - Type UnspecifiedMEDICARE