Provider Demographics
NPI:1467979419
Name:DOCTOR OF CHIROPRACTIC AND HEALTH SCIENCE PLLC
Entity Type:Organization
Organization Name:DOCTOR OF CHIROPRACTIC AND HEALTH SCIENCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-425-9810
Mailing Address - Street 1:642 CHANCELLOR DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3377
Mailing Address - Country:US
Mailing Address - Phone:616-295-7665
Mailing Address - Fax:
Practice Address - Street 1:4415 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4800
Practice Address - Country:US
Practice Address - Phone:616-534-2944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty