Healthcare Provider Details

I. General information

NPI: 1073807350
Provider Name (Legal Business Name): SHANA LYNN CANFIELD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANA LYNN MCLAUGHLIN D.C.

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 FULLER AVE NE
GRAND RAPIDS MI
49503-1901
US

IV. Provider business mailing address

831 FULLER AVE NE
GRAND RAPIDS MI
49503-1901
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-8063
  • Fax: 616-458-6711
Mailing address:
  • Phone: 616-458-8063
  • Fax: 616-458-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009719
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: