Provider Demographics
NPI:1679576425
Name:WETHERBEE, JOHN M (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:WETHERBEE
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 1:8619 W GRAND RIVER AVE
Mailing Address - Street 2:STE B
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2334
Mailing Address - Country:US
Mailing Address - Phone:810-225-7350
Mailing Address - Fax:
Practice Address - Street 1:8619 W GRAND RIVER AVE
Practice Address - Street 2:STE B
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2334
Practice Address - Country:US
Practice Address - Phone:810-225-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2009-06-10
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MI2301007958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D712120OtherBCBS GROUP PIN
MIX6D24OtherEMPIRE BCBS PIN
MI950D712120OtherBCBS GROUP PIN
MIX6D24OtherEMPIRE BCBS PIN