Provider Demographics
NPI:1982963161
Name:ZUIDEMA, LANCE CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:CHARLES
Last Name:ZUIDEMA
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 1:36 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2177
Mailing Address - Country:US
Mailing Address - Phone:616-457-5700
Mailing Address - Fax:616-457-1795
Practice Address - Street 1:36 44TH ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2177
Practice Address - Country:US
Practice Address - Phone:616-457-9900
Practice Address - Fax:616-457-9910
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor