Healthcare Provider Details

I. General information

NPI: 1275788374
Provider Name (Legal Business Name): KELLEN IAN BRUSVEEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5164 LAKE MICHIGAN DR STE D
ALLENDALE MI
49401-8506
US

IV. Provider business mailing address

5164 LAKE MICHIGAN DR STE D
ALLENDALE MI
49401-8506
US

V. Phone/Fax

Practice location:
  • Phone: 616-777-0309
  • Fax: 616-777-0523
Mailing address:
  • Phone: 616-777-0309
  • Fax: 616-777-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009471
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: