Provider Demographics
NPI:1780488551
Name:JACHIMIAK, ALIVIA (STUDENT)
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:
Last Name:JACHIMIAK
Suffix:
Gender:
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 N SHERMAN DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2276
Mailing Address - Country:US
Mailing Address - Phone:574-344-7060
Mailing Address - Fax:
Practice Address - Street 1:965 WILSON RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-6410
Practice Address - Country:US
Practice Address - Phone:517-353-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program