MEDICARE: DR. LANCE CHARLES ZUIDEMA D.C.

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	2301009887	MI

General Provider Information

NPI Number	:	1982963161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANCE CHARLES ZUIDEMA D.C.

Provider Business Mailing Address
First Line	:	36 44TH ST SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2177
Country	:	US
Telephone Number	:	616-457-5700
Fax Number	:	616-457-1795

Provider Business Practice Location Address
First Line	:	36 44TH ST SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2177
Country	:	US
Telephone Number	:	616-457-9900
Fax Number	:	616-457-9910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	01/28/2020

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