Provider Demographics
NPI:1407333966
Name:HANDLEY, KAITLYN ANN (DC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:HANDLEY
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 1:509 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4750
Mailing Address - Country:US
Mailing Address - Phone:616-455-7040
Mailing Address - Fax:616-455-0189
Practice Address - Street 1:1586 44TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4314
Practice Address - Country:US
Practice Address - Phone:616-455-7040
Practice Address - Fax:616-455-0189
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor