Healthcare Provider Details

I. General information

NPI: 1003794967
Provider Name (Legal Business Name): XENIA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 36TH ST SE
GRAND RAPIDS MI
49512-2056
US

IV. Provider business mailing address

900 GRIGGS ST SE
GRAND RAPIDS MI
49507-2732
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-1120
  • Fax:
Mailing address:
  • Phone: 616-427-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: