Healthcare Provider Details

I. General information

NPI: 1912267923
Provider Name (Legal Business Name): CATHERINE MARIE VAN TIL L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 BELTLINE CT NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

4 BURR OAK ST NE
GRAND RAPIDS MI
49505-6213
US

V. Phone/Fax

Practice location:
  • Phone: 616-485-8265
  • Fax:
Mailing address:
  • Phone: 616-485-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2581040301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: