Provider Demographics
NPI:1508088568
Name:CHADFIELD, LYNNE M (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:M
Last Name:CHADFIELD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LYNNE
Other - Middle Name:M
Other - Last Name:CHADFIELD-WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-3140
Mailing Address - Country:US
Mailing Address - Phone:616-459-0898
Mailing Address - Fax:616-459-6963
Practice Address - Street 1:1025 SPAULDING AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8417
Practice Address - Country:US
Practice Address - Phone:616-940-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015653207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101015653OtherPHYSICIAN LICENSE NO.
MI5321251Medicaid
MI5315019040OtherBOARD OF PHARMACY CONTROL
MI0P62110Medicare PIN
MI0P62110Medicare PIN