MEDICARE: WESTSIDE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1942938550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	3888 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4521
Country	:	US
Telephone Number	:	616-747-8462
Fax Number	:	616-841-9693

Provider Business Practice Location Address
First Line	:	3888 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-4521
Country	:	US
Telephone Number	:	616-747-8462
Fax Number	:	616-841-9693

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REBECCA DEYO
Credential	:	DC
Telephone Number	:	616-747-8462

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Directions to “WESTSIDE CHIROPRACTIC LLC ” Practice Location

Language	Start Address	Practice Location

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