Healthcare Provider Details

I. General information

NPI: 1851495840
Provider Name (Legal Business Name): LINDA S SQUIRES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 06/16/2014
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: 616-363-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1132
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number230101064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: