Healthcare Provider Details

I. General information

NPI: 1982724696
Provider Name (Legal Business Name): STEPHEN MICHAEL DURELL R.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 MICHIGAN ST NE STE A
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

2815 MICHIGAN ST NE STE A.
GRAND RAPIDS MI
49506
US

V. Phone/Fax

Practice location:
  • Phone: 616-855-7718
  • Fax: 616-855-2977
Mailing address:
  • Phone: 616-855-7718
  • Fax: 616-855-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5401000089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: