Healthcare Provider Details

I. General information

NPI: 1841792660
Provider Name (Legal Business Name): AFFORDABLE HEARING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 KENMOOR AVE SE STE G
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

833 KENMOOR AVE SE STE G
GRAND RAPIDS MI
49546-2390
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-2882
  • Fax:
Mailing address:
  • Phone: 616-591-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501004977
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN PETER JENDRASIAK II
Title or Position: OWNER
Credential: BA, HAD
Phone: 616-591-2882