Healthcare Provider Details

I. General information

NPI: 1871851337
Provider Name (Legal Business Name): SARVER CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 KENMOOR AVE SE
GRAND RAPIDS MI
49546-2370
US

IV. Provider business mailing address

723 KENMOOR AVE SE
GRAND RAPIDS MI
49546-2370
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-3300
  • Fax: 616-956-5519
Mailing address:
  • Phone: 616-949-3300
  • Fax: 616-956-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301005689
License Number StateMI

VIII. Authorized Official

Name: DR. KEITH ANDREW SARVER
Title or Position: OWNER
Credential: DC
Phone: 616-949-3300