1841210416 NPI number — DE LEEUW CHIROPRACTIC CENTER PC

Table of content: (NPI 1841210416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841210416 NPI number — DE LEEUW CHIROPRACTIC CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DE LEEUW CHIROPRACTIC CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841210416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
081 LAKE MICHIGAN DRIVE, NW
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:
49534-8722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-453-4437
Provider Business Mailing Address Fax Number:
616-453-4308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
738 32ND ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49548-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-243-1444
Provider Business Practice Location Address Fax Number:
616-243-2434
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DE LEEUW
Authorized Official First Name:
WARNER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
616-453-4437

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301004568 , 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)

  • Identifier: 950D151090 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com