Individual
CHARLES SCOTT KOOISTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2855 BYRON CENTER AVE SW, WYOMING, MI 49519-2415
(616) 532-2518
(616) 532-2696
Mailing address
2855 BYRON CENTER AVE SW, WYOMING, MI 49519-2415
(616) 532-2518
(616) 532-2696
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CK002664
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950D150810
BCBS
—
Enumeration date
09/20/2005
Last updated
02/03/2017
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