Provider Demographics
NPI:1457631236
Name:HINMAN, AILEEN BOYD (LAC MSAOM)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:BOYD
Last Name:HINMAN
Suffix:
Gender:F
Credentials:LAC MSAOM
Other - Prefix:MS
Other - First Name:AILEEN
Other - Middle Name:MARIE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC MSAOM
Mailing Address - Street 1:835 EDNA ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3701
Mailing Address - Country:US
Mailing Address - Phone:607-227-4984
Mailing Address - Fax:
Practice Address - Street 1:435 CHERRY ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4672
Practice Address - Country:US
Practice Address - Phone:607-227-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist