Provider Demographics
NPI:1861075772
Name:HOUCHEN, CRAIG
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:HOUCHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2032
Mailing Address - Country:US
Mailing Address - Phone:616-356-1805
Mailing Address - Fax:
Practice Address - Street 1:1400 MICHIGAN ST NE STE 2N
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2032
Practice Address - Country:US
Practice Address - Phone:616-356-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5402000047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty