Provider Demographics
NPI:1043297161
Name:GRIFHORST, KATHI JUNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHI
Middle Name:JUNE
Last Name:GRIFHORST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHI
Other - Middle Name:JUNE
Other - Last Name:BEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12489 18 MILE RD
Mailing Address - Street 2:
Mailing Address - City:GOWEN
Mailing Address - State:MI
Mailing Address - Zip Code:49326-9732
Mailing Address - Country:US
Mailing Address - Phone:616-984-9983
Mailing Address - Fax:616-984-9983
Practice Address - Street 1:12489 18 MILE RD
Practice Address - Street 2:
Practice Address - City:GOWEN
Practice Address - State:MI
Practice Address - Zip Code:49326-9732
Practice Address - Country:US
Practice Address - Phone:616-984-9983
Practice Address - Fax:616-984-9983
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P01690Medicare ID - Type Unspecified