Provider Demographics
NPI:1659698140
Name:DEVRIES, DOUGLAS ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROGER
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 CHERRY ST SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4672
Mailing Address - Country:US
Mailing Address - Phone:616-233-0960
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:616-233-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor