Provider Demographics
NPI:1427607522
Name:MANIER, MADELINE DEJONGE (DACM, LAC, DIPL OM)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:DEJONGE
Last Name:MANIER
Suffix:
Gender:F
Credentials:DACM, LAC, DIPL OM
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:LEE
Other - Last Name:DEJONGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DACM, LAC, DIPL OM
Mailing Address - Street 1:2910 63RD ST
Mailing Address - Street 2:
Mailing Address - City:FENNVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49408
Mailing Address - Country:US
Mailing Address - Phone:616-416-0746
Mailing Address - Fax:
Practice Address - Street 1:442 CENTURY LANE
Practice Address - Street 2:SUITE 300
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-416-0746
Practice Address - Fax:616-344-4030
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000268171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist