Healthcare Provider Details

I. General information

NPI: 1013312800
Provider Name (Legal Business Name): ALEXANDER LE BON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2757 LEONARD ST NE STE 200
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

2757 LEONARD ST NE STE 200
GRAND RAPIDS MI
49525-5807
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-8063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: