Healthcare Provider Details

I. General information

NPI: 1861075772
Provider Name (Legal Business Name): CRAIG HOUCHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MICHIGAN ST NE STE 2N
GRAND RAPIDS MI
49503-2032
US

IV. Provider business mailing address

1400 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2032
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-1805
  • Fax:
Mailing address:
  • Phone: 616-356-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5402000047
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: