MEDICARE: NATHAN CHARLES SOUTHERINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1528543915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN CHARLES SOUTHERINGTON

Provider Business Mailing Address
First Line	:	3560 LONG GROVE DR SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49512-9365
Country	:	US
Telephone Number	:	616-822-4525
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 LONG GROVE DR SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49512-9365
Country	:	US
Telephone Number	:	616-822-4525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	10/01/2018

Similar Medicare Providers

1114863388 — JOSHUA PAUL LANGE
Practice Location Address:

3361 36TH ST SE
KENTWOOD, MI
49512-2809

Practice Phone: 616-942-2522
Practice Fax:

1942911581 — STEPHANIE MEWBOURN
Practice Location Address:

3361 36TH ST SE
KENTWOOD, MI
49512-2809

Practice Phone: 616-942-2522
Practice Fax:

1225712433 — GRANT MICHAEL VANDERKLIPP
Practice Location Address:

3361 36TH ST SE
KENTWOOD, MI
49512-2809

Practice Phone: 616-301-8000
Practice Fax:

1699771485 — DR. JACK W. URBEN PHARM.D.
Practice Location Address:

3031 POPLAR CREEK DR SE , UNIT 103
KENTWOOD, MI
49512-5667

Practice Phone: 616-949-9573
Practice Fax: 616-975-7596

1598750416 — LYNNETTE GAY DOARNBERGER O.D.
Practice Location Address:

3230 BROADMOOR AVE SE STE A
KENTWOOD, MI
49512-8180

Practice Phone: 616-534-4953
Practice Fax:

1811975717 — GREAT LAKES FAMILY CHIROPRACTIC, INC.
Practice Location Address:

3138 BROADMOOR AVE SE
KENTWOOD, MI
49512-1845

Practice Phone: 616-241-4040
Practice Fax: 616-475-6953

Directions to “ NATHAN CHARLES SOUTHERINGTON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.