1457631236 NPI number — AILEEN BOYD HINMAN L.AC. MSAOM

Table of content: AILEEN BOYD HINMAN L.AC. MSAOM (NPI 1457631236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457631236 NPI number — AILEEN BOYD HINMAN L.AC. MSAOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINMAN
Provider First Name:
AILEEN
Provider Middle Name:
BOYD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC. MSAOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYD
Provider Other First Name:
AILEEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAC. MSAOM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457631236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 EDNA ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49507-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-227-4984
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 CHERRY ST SE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-4672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-227-4984
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  5401000183 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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