Healthcare Provider Details

I. General information

NPI: 1851662076
Provider Name (Legal Business Name): KATHERINE LYZENGA-DEAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 HENRY ST
ALLENDALE MI
49401-9714
US

IV. Provider business mailing address

6560 HENRY ST
ALLENDALE MI
49401-9714
US

V. Phone/Fax

Practice location:
  • Phone: 616-293-3094
  • Fax:
Mailing address:
  • Phone: 616-293-3094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009902
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: