Provider Demographics
NPI:1205212719
Name:HUISMAN, DANA BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:BETH
Last Name:HUISMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 E LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2000
Mailing Address - Country:US
Mailing Address - Phone:616-392-2166
Mailing Address - Fax:616-396-0589
Practice Address - Street 1:84 E LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2000
Practice Address - Country:US
Practice Address - Phone:616-392-2166
Practice Address - Fax:616-396-0589
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor