Provider Demographics
NPI:1871779421
Name:KOOYERS, AMY M (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:KOOYERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:TIMKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7199 KALAMAZOO AVE SE
Mailing Address - Street 2:SUITE 234
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7199 KALAMAZOO AVE SE
Practice Address - Street 2:SUITE 234
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7341
Practice Address - Country:US
Practice Address - Phone:517-604-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor