Provider Demographics
NPI:1871609594
Name:DOUBLE, BRAD ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALLEN
Last Name:DOUBLE
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 1:1211 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3729
Mailing Address - Country:US
Mailing Address - Phone:517-990-0555
Mailing Address - Fax:517-990-0550
Practice Address - Street 1:1211 WARREN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3729
Practice Address - Country:US
Practice Address - Phone:517-900-0555
Practice Address - Fax:517-990-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D61058OtherBCBS
MIBD005774Medicare UPIN
MI0N91130Medicare ID - Type Unspecified