Provider Demographics
NPI:1033432810
Name:LENGKEEK, JEREMY RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:RYAN
Last Name:LENGKEEK
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 1:364 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8656
Mailing Address - Country:US
Mailing Address - Phone:616-392-9500
Mailing Address - Fax:616-392-9662
Practice Address - Street 1:364 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8656
Practice Address - Country:US
Practice Address - Phone:616-392-9500
Practice Address - Fax:616-392-9662
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor