Healthcare Provider Details

I. General information

NPI: 1669502654
Provider Name (Legal Business Name): CEDAR SPRINGS FAMILY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S MAIN SUITE 4
CEDAR SPRINGS MI
49319-8950
US

IV. Provider business mailing address

151 S MAIN SUITE 4
CEDAR SPRINGS MI
49319-8950
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-2688
  • Fax: 616-696-2663
Mailing address:
  • Phone: 616-696-2688
  • Fax: 616-696-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberGB007557
License Number StateMI

VIII. Authorized Official

Name: DR. GRANT JAMES BUCK
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 616-696-2663