Provider Demographics
NPI:1518312537
Name:HARVEY, THERESA LOUISE (DC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
Last Name:HARVEY
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 1:4084 LAKESHORE DR N
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-5625
Mailing Address - Country:US
Mailing Address - Phone:207-951-6654
Mailing Address - Fax:
Practice Address - Street 1:302 S BEECHTREE ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2071
Practice Address - Country:US
Practice Address - Phone:616-846-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor