Healthcare Provider Details

I. General information

NPI: 1114337094
Provider Name (Legal Business Name): MONICA RASMUSSEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 WEALTHY ST SE STE 220
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

2213 WEALTHY ST SE STE 220
GRAND RAPIDS MI
49506-3054
US

V. Phone/Fax

Practice location:
  • Phone: 616-510-3343
  • Fax: 616-458-2342
Mailing address:
  • Phone: 616-510-3343
  • Fax: 616-458-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: