Provider Demographics
NPI:1306200431
Name:INDEPENDENCE HEALTH, PLLC
Entity Type:Organization
Organization Name:INDEPENDENCE HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEZGODA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-427-3077
Mailing Address - Street 1:5360 EASTERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6018
Mailing Address - Country:US
Mailing Address - Phone:616-427-3077
Mailing Address - Fax:616-323-0773
Practice Address - Street 1:5360 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6018
Practice Address - Country:US
Practice Address - Phone:616-427-3077
Practice Address - Fax:616-323-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty