Provider Demographics
NPI:1952368375
Name:VAN KINTS, RONALD M (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:VAN KINTS
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 1:509 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423
Mailing Address - Country:US
Mailing Address - Phone:616-396-4400
Mailing Address - Fax:616-392-8645
Practice Address - Street 1:509 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-396-4400
Practice Address - Fax:616-392-8645
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950G011040OtherBCBS GROUP
MI4354893Medicaid
RV005417OtherBCBS
MIN77240001Medicare ID - Type Unspecified
MI0N77240Medicare ID - Type UnspecifiedGROUP
950G011040OtherBCBS GROUP