Healthcare Provider Details

I. General information

NPI: 1053042747
Provider Name (Legal Business Name): HOLLAND SPINE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 JAMES ST STE B65
HOLLAND MI
49424-8579
US

IV. Provider business mailing address

12330 JAMES ST STE B65
HOLLAND MI
49424-8579
US

V. Phone/Fax

Practice location:
  • Phone: 567-525-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIAN JAMES KOCH
Title or Position: OWNER/ CHIROPRACTIC PHYSICIAN
Credential: DC, CERT. MDT
Phone: 567-525-2778