Provider Demographics
NPI:1518263672
Name:VANKOEVERING, LAINA M (DC)
Entity Type:Individual
Prefix:
First Name:LAINA
Middle Name:M
Last Name:VANKOEVERING
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 1:705 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1414
Mailing Address - Country:US
Mailing Address - Phone:231-924-6940
Mailing Address - Fax:231-924-2760
Practice Address - Street 1:705 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1414
Practice Address - Country:US
Practice Address - Phone:231-924-6940
Practice Address - Fax:231-924-2760
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor