Healthcare Provider Details

I. General information

NPI: 1457631236
Provider Name (Legal Business Name): AILEEN BOYD HINMAN L.AC. MSAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AILEEN MARIE BOYD LAC. MSAOM

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 CHERRY ST SE SUITE B
GRAND RAPIDS MI
49503-4672
US

IV. Provider business mailing address

835 EDNA ST SE
GRAND RAPIDS MI
49507-3701
US

V. Phone/Fax

Practice location:
  • Phone: 607-227-4984
  • Fax:
Mailing address:
  • Phone: 607-227-4984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5401000183
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: