Healthcare Provider Details

I. General information

NPI: 1356221683
Provider Name (Legal Business Name): CHRISTIAN HENRY MULLETT L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 KALAMAZOO AVE SE
GRAND RAPIDS MI
49508-1475
US

IV. Provider business mailing address

13206 WOODROW AVE NW
GRAND RAPIDS MI
49534-1054
US

V. Phone/Fax

Practice location:
  • Phone: 616-438-8881
  • Fax:
Mailing address:
  • Phone: 616-438-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5402000289
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: