Provider Demographics
NPI:1124616412
Name:LOHMAN, ADDISON (DC)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:
Last Name:LOHMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:
Other - Last Name:WALSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:620 HOLTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-3343
Mailing Address - Country:US
Mailing Address - Phone:231-744-5200
Mailing Address - Fax:231-744-9484
Practice Address - Street 1:1877 N GETTY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-8563
Practice Address - Country:US
Practice Address - Phone:231-744-5200
Practice Address - Fax:231-744-9484
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301011038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301011038OtherSTATE LICENSE