Provider Demographics
NPI:1851003529
Name:UNBOUND HEALING MINISTRIES
Entity Type:Organization
Organization Name:UNBOUND HEALING MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:NOISEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-528-0099
Mailing Address - Street 1:2 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4128
Mailing Address - Country:US
Mailing Address - Phone:616-528-0099
Mailing Address - Fax:
Practice Address - Street 1:2 W 19TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4128
Practice Address - Country:US
Practice Address - Phone:616-528-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902515596Medicaid