Provider Demographics
NPI:1891533345
Name:DEWEERD, CONNOR
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:
Last Name:DEWEERD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15004 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1405
Mailing Address - Country:US
Mailing Address - Phone:616-953-2160
Mailing Address - Fax:
Practice Address - Street 1:300 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1207
Practice Address - Country:US
Practice Address - Phone:517-629-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor