Healthcare Provider Details

I. General information

NPI: 1598001885
Provider Name (Legal Business Name): MUSCLE SCIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 OLD 28TH ST SE SUITE #201
GRAND RAPIDS MI
49546-6954
US

IV. Provider business mailing address

6660 OLD 28TH ST SE SUITE #201
GRAND RAPIDS MI
49546-6954
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-0833
  • Fax: 616-949-1126
Mailing address:
  • Phone: 616-920-0833
  • Fax: 616-949-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2301009981
License Number StateMN

VIII. Authorized Official

Name: DR. BRIAN WAYNE HANKS
Title or Position: OWNER
Credential: D.C.
Phone: 616-920-0833