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General NPI Number Information
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NPI Number | 1467755686
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Entity Type | Organization
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Legal Business Name | THRIVE CHIROPRACTIC CENTER PLC
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 2422 BURTON ST SE STE F
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4809
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Country | US
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Telephone | 616-554-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 2422 BURTON ST SE STE F
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4809
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Country | US
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Telephone | 616-554-5070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA TAVEN TIJERINA
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Credential |
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Telephone | 231-920-4264
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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 | 2301009423
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License Number State | MI
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