Healthcare Provider Details

I. General information

NPI: 1104757244
Provider Name (Legal Business Name): LAUREN KLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5738 FOREMOST DR SE STE 300
GRAND RAPIDS MI
49546-7068
US

IV. Provider business mailing address

17 MANZANA CT NW APT 3B
GRAND RAPIDS MI
49534-5775
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-2503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2301401742
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: