Provider Demographics
NPI:1811440167
Name:PRINS, JACQUELINE LAURA (DC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LAURA
Last Name:PRINS
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 1:653 E 128TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-9652
Mailing Address - Country:US
Mailing Address - Phone:408-679-4238
Mailing Address - Fax:
Practice Address - Street 1:5211 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1447
Practice Address - Country:US
Practice Address - Phone:616-426-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor