Healthcare Provider Details

I. General information

NPI: 1770761314
Provider Name (Legal Business Name): LYNNE CHADFIELD DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SPAULDING SE SUITE B
GRAND RAPIDS MI
49546-8417
US

IV. Provider business mailing address

PO BOX 3140
GRAND RAPIDS MI
49501-3140
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-2795
  • Fax:
Mailing address:
  • Phone: 616-459-6867
  • Fax: 616-591-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNNE M CHADFIELD
Title or Position: OWNER
Credential: DO
Phone: 616-940-2795