Provider Demographics
NPI:1407413768
Name:HAAGSMA, LUKE DAVID (DC)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:DAVID
Last Name:HAAGSMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 BROADMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7329
Mailing Address - Country:US
Mailing Address - Phone:616-698-0046
Mailing Address - Fax:616-698-2188
Practice Address - Street 1:7101 BROADMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7329
Practice Address - Country:US
Practice Address - Phone:616-698-0046
Practice Address - Fax:616-698-2188
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401590111N00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant