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General NPI Number Information
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NPI Number | 1467979419
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Entity Type | Organization
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Legal Business Name | DOCTOR OF CHIROPRACTIC AND HEALTH SCIENCE PLLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 4415 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-4800
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Country | US
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Telephone | 616-534-2944
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Fax |
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Provider Business Mailing Address
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Address Line | 642 CHANCELLOR DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-3377
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Country | US
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Telephone | 616-295-7665
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JESSICA MARIE LOPEZ
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Credential | DC
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Telephone | 616-425-9810
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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 | 2301010535
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License Number State | MI
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