Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1104855006 | MI |
NPI | 1003457532 |
---|---|
Provider Name | Isaiah Avink |
First Address | East Lansing, MI 48823-8444 |
Second Address | East Lansing, MI 48823-8444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2019 |
Last Update Date | 15/12/2019 |