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General NPI Number Information
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NPI Number | 1740191832
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Entity Type | Organization
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Legal Business Name | LAKESIDE OSTEOPATHIC MANIPULATIVE MEDICINE PLLC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 1180 OTTAWA BEACH RD STE 3
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City | HOLLAND
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State | MI
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Zip | 49424-2597
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Country | US
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Telephone | 616-251-1815
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Fax | 616-251-1202
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Provider Business Mailing Address
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Address Line | 1180 OTTAWA BEACH RD STE 3
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City | HOLLAND
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State | MI
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Zip | 49424-2597
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Country | US
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Telephone | 616-251-1815
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Fax | 616-251-1202
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MADELINE GINN-TERPSTRA
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Credential | DO
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Telephone | 616-251-1815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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