Provider Demographics
NPI:1326194796
Name:HOLLAND CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:HOLLAND CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VAN KINTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-396-4400
Mailing Address - Street 1:509 MICHIGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423
Mailing Address - Country:US
Mailing Address - Phone:616-396-4400
Mailing Address - Fax:616-392-8645
Practice Address - Street 1:509 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-396-4400
Practice Address - Fax:616-392-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005417111N00000X
MI2301009070111N00000X
MI2301002047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
950G011040OtherBCBS
U23011Medicare UPIN
950G011040OtherBCBS