Provider Demographics
NPI:1891791331
Name:DELEEUW, WARNER (DC)
Entity Type:Individual
Prefix:
First Name:WARNER
Middle Name:
Last Name:DELEEUW
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 1:738 32ND ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-2329
Mailing Address - Country:US
Mailing Address - Phone:616-243-1444
Mailing Address - Fax:616-243-2434
Practice Address - Street 1:738 32ND ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-2329
Practice Address - Country:US
Practice Address - Phone:616-243-1444
Practice Address - Fax:616-243-2434
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891791331Medicaid
MI1891791331Medicaid
MI1891791331Medicare PIN