Provider Demographics
NPI:1437133865
Name:NIENHUIS, LEONARD HARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:HARRY
Last Name:NIENHUIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7579 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9251
Mailing Address - Country:US
Mailing Address - Phone:616-457-4511
Mailing Address - Fax:616-667-1936
Practice Address - Street 1:7579 MAIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9251
Practice Address - Country:US
Practice Address - Phone:616-457-4511
Practice Address - Fax:616-667-1936
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILN003038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G05036OtherBLUE CROSS/BLUE SHIELD