Healthcare Provider Details

I. General information

NPI: 1740191832
Provider Name (Legal Business Name): LAKESIDE OSTEOPATHIC MANIPULATIVE MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 OTTAWA BEACH RD STE 3
HOLLAND MI
49424-2597
US

IV. Provider business mailing address

1180 OTTAWA BEACH RD STE 3
HOLLAND MI
49424-2597
US

V. Phone/Fax

Practice location:
  • Phone: 616-251-1815
  • Fax: 616-251-1202
Mailing address:
  • Phone: 616-251-1815
  • Fax: 616-251-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MADELINE GINN-TERPSTRA
Title or Position: SOLE MEMBER
Credential: DO
Phone: 616-251-1815