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General NPI Number Information
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NPI Number | 1104226067
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Entity Type | Organization
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Legal Business Name | LINDA S. SQUIRES, D.C., P.C.
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 3368 E BELTLINE CT NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9480
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Country | US
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Telephone | 800-987-1368
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Fax | 616-363-6679
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Provider Business Mailing Address
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Address Line | 2059 COLLEGE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3101
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Country | US
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Telephone | 617-538-8152
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Fax | 616-363-6679
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LIND SUE SQUIRES
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Credential | D.C.
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Telephone | 617-538-8152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301010164
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License Number State | MI
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