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General NPI Number Information
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NPI Number | 1801292230
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Entity Type | Organization
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Legal Business Name | ROOTS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 9479 RILEY ST STE 245
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City | ZEELAND
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State | MI
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Zip | 49464-8750
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Country | US
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Telephone | 616-239-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 388 GARDEN AVE STE 140
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City | HOLLAND
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State | MI
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Zip | 49424-8999
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Country | US
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Telephone | 616-294-1073
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. MATTHEW ZIESEMER
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Credential | DC
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Telephone | 616-485-2816
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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 | L2325578
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License Number State | MI
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