Healthcare Provider Details

I. General information

NPI: 1114057460
Provider Name (Legal Business Name): KILPATRICK CHIROPRACTIC LIFE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1603
US

IV. Provider business mailing address

4270 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1603
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-6275
  • Fax: 616-364-6299
Mailing address:
  • Phone: 616-364-6275
  • Fax: 616-364-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004267
License Number StateMI

VIII. Authorized Official

Name: DR. KERRY THOMAS KILPATRICK
Title or Position: OWNER
Credential: D.C.
Phone: 616-364-6275