Healthcare Provider Details

I. General information

NPI: 1104226067
Provider Name (Legal Business Name): LINDA S. SQUIRES, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 E BELTLINE CT NE
GRAND RAPIDS MI
49525-9480
US

IV. Provider business mailing address

2059 COLLEGE AVE SE
GRAND RAPIDS MI
49507-3101
US

V. Phone/Fax

Practice location:
  • Phone: 800-987-1368
  • Fax: 616-363-6679
Mailing address:
  • Phone: 617-538-8152
  • Fax: 616-363-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010164
License Number StateMI

VIII. Authorized Official

Name: DR. LIND SUE SQUIRES
Title or Position: PRESIDENT
Credential: D.C.
Phone: 617-538-8152