Provider Demographics
NPI:1902515596
Name:NOISEAU, CLINT JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:JASON
Last Name:NOISEAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4128
Mailing Address - Country:US
Mailing Address - Phone:616-528-0099
Mailing Address - Fax:
Practice Address - Street 1:2 W 19TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4128
Practice Address - Country:US
Practice Address - Phone:616-528-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC.4882111N00000X
MI2301401274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor