CHARLES SCOTT KOOISTRA DC - NPI 1417943036 - Chiropractor in Wyoming, MI

Q: What is the provider's specialty?

The provider's specialty is Chiropractor with taxonomy code 111N00000X.

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About Charles Scott Kooistra Dc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLES SCOTT KOOISTRA DC (NPI 1417943036) is an individual chiropractor in Wyoming, Michigan, licensed in Michigan (CK002664) and active in the NPI registry since September 2005.

NPPES Registry Identity

NPI1417943036

Entity TypeIndividualMale

Primary Taxonomy111N00000X

Provider Legal NameCHARLES SCOTT KOOISTRACredential: DC

Location Address2855 BYRON CENTER AVE SWWyoming, MI 49519-2415

Mailing Address2855 Byron Center Ave SwWyoming, MI 49519-2415 · (616) 532-2518 · Fax (616) 532-2696

Phone(616) 532-2518

Fax(616) 532-2696

Sole ProprietorYes

Enumeration DateSeptember 20, 2005

Last NPPES UpdateFebruary 3, 2017

✔ NPI 1417943036 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers

Taxonomy Code111N00000X

License✔ Licensed in MI · CK002664

Definition

A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

2855 BYRON CENTER AVE SW, Wyoming, MI 49519

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Other Identifiers 4

Medicare UPINT33011

Medicare ID-Type Unspecified0D15081

Medicare ID-Type Unspecified350058662

Other950D150810Bcbs

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GERALD B KOOISTRA DC

Chiropractor