Provider Demographics
NPI:1609072339
Name:BAKIAN, COREY EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:EDWARD
Last Name:BAKIAN
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 1:450 E. MICH. AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1684
Mailing Address - Country:US
Mailing Address - Phone:248-202-7322
Mailing Address - Fax:
Practice Address - Street 1:450 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1684
Practice Address - Country:US
Practice Address - Phone:734-429-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH15052Medicare ID - Type Unspecified
MIP51064Medicare UPIN