Provider Demographics
NPI:1326076415
Name:DE YOUNG CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:DE YOUNG CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:DE YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-281-2500
Mailing Address - Street 1:400 68TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7120
Mailing Address - Country:US
Mailing Address - Phone:616-281-2500
Mailing Address - Fax:616-281-2502
Practice Address - Street 1:400 68TH ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-7120
Practice Address - Country:US
Practice Address - Phone:616-281-2500
Practice Address - Fax:616-281-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV08054Medicare UPIN