Healthcare Provider Details

I. General information

NPI: 1467755686
Provider Name (Legal Business Name): THRIVE CHIROPRACTIC CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 BURTON ST SE STE F
GRAND RAPIDS MI
49546-4809
US

IV. Provider business mailing address

2422 BURTON ST SE STE F
GRAND RAPIDS MI
49546-4809
US

V. Phone/Fax

Practice location:
  • Phone: 616-554-5070
  • Fax:
Mailing address:
  • Phone: 616-554-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009423
License Number StateMI

VIII. Authorized Official

Name: REBECCA TAVEN TIJERINA
Title or Position: OWNER
Credential:
Phone: 231-920-4264