Healthcare Provider Details

I. General information

NPI: 1750676409
Provider Name (Legal Business Name): CLEAR CONNECTIONS CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E BELTLINE AVE SE SUITE 145
GRAND RAPIDS MI
49506-4361
US

IV. Provider business mailing address

1500 E BELTLINE AVE SE SUITE 145
GRAND RAPIDS MI
49506-4361
US

V. Phone/Fax

Practice location:
  • Phone: 616-608-3606
  • Fax: 616-551-3233
Mailing address:
  • Phone: 616-608-3606
  • Fax: 616-551-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009827
License Number StateMI

VIII. Authorized Official

Name: KRYSTAL CZEGUS
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 586-255-2772