Healthcare Provider Details

I. General information

NPI: 1235453895
Provider Name (Legal Business Name): BRUCE E POMMERENING CMT, CR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 BUTTERNUT DR OFFICE ENTRANCE
HOLLAND MI
49424-1517
US

IV. Provider business mailing address

868 BUTTERNUT DR
HOLLAND MI
49424-1517
US

V. Phone/Fax

Practice location:
  • Phone: 616-796-4618
  • Fax:
Mailing address:
  • Phone: 616-796-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: