Jack De Boer, CCC-A

Primary specialty

AudiologistTaxonomy code 231H00000X

License

1601000343 Issued in MI

Practice address

2036 Chesaning Dr SE
Grand Rapids, MI 49506-5309

Phone

(616) 819-3070

Fax

(616) 819-3239

NPI assigned

Nov 10, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226275200000",
    "number": "1750535373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2036 CHESANING DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495065309",
            "telephone_number": "616-819-3070",
            "fax_number": "616-819-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2036 CHESANING DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495065309",
            "telephone_number": "616-819-3070",
            "fax_number": "616-819-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE BOER",
        "first_name": "JACK",
        "name_prefix": "Mr.",
        "credential": "CCC-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-10",
        "last_updated": "2008-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "1601000343",
            "primary": true
        },
        {
            "code": "231HA2400X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Practitioner",
            "state": "MI",
            "license": "1601000342",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "MI",
            "license": "1601000343",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• DC Healthy Living Center
• DCM5 LLC
• Christine De Anna, RN
• James Bernard De Boe, PH.D.
• Mattie A De Boe, LMSW
• Joshua Jan De Castro, RPH
• Steven Renze De Groot, PH.D
• Michelle Del Castillo De Jesus Brazitis, M.D.
• Julia Bernice De Jonge, PHD
• Eva Marie De la Cruz

• Audiologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Audiologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.