Provider Demographics
NPI:1356221683
Name:MULLETT, CHRISTIAN HENRY (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:HENRY
Last Name:MULLETT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13206 WOODROW AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1054
Mailing Address - Country:US
Mailing Address - Phone:616-438-8881
Mailing Address - Fax:
Practice Address - Street 1:3167 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1475
Practice Address - Country:US
Practice Address - Phone:616-438-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5402000289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist