Provider Demographics
NPI:1376887638
Name:ALMOND LEAF CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:ALMOND LEAF CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEVREUGD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-874-7255
Mailing Address - Street 1:6411 BELLA VISTA DR NE
Mailing Address - Street 2:STE #2
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7869
Mailing Address - Country:US
Mailing Address - Phone:616-874-7255
Mailing Address - Fax:616-874-7196
Practice Address - Street 1:6411 BELLA VISTA DR NE
Practice Address - Street 2:STE #2
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7869
Practice Address - Country:US
Practice Address - Phone:616-874-7255
Practice Address - Fax:616-874-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty