Healthcare Provider Details

I. General information

NPI: 1558241109
Provider Name (Legal Business Name): LISA BRUNETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6534 LAKE MICHIGAN DR
ALLENDALE MI
49401-9228
US

IV. Provider business mailing address

10891 2ND AVE NW
GRAND RAPIDS MI
49534-5892
US

V. Phone/Fax

Practice location:
  • Phone: 616-895-5499
  • Fax:
Mailing address:
  • Phone: 616-570-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: