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General NPI Number Information
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NPI Number | 1912267923
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Entity Type | Individual
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Provider Name | CATHERINE MARIE VAN TIL L.AC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 3368 BELTLINE CT NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525
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Country | US
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Telephone | 616-485-8265
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BURR OAK ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-6213
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Country | US
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Telephone | 616-485-8265
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 2581040301
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License Number State | MI
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