Provider Demographics
NPI:1053605782
Name:MEDLIN, SEAN ANSON (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ANSON
Last Name:MEDLIN
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 1:1500 E BELTLINE AVE SE
Mailing Address - Street 2:145
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4361
Mailing Address - Country:US
Mailing Address - Phone:703-606-8287
Mailing Address - Fax:
Practice Address - Street 1:1500 E BELTLINE AVE SE
Practice Address - Street 2:145
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4361
Practice Address - Country:US
Practice Address - Phone:703-606-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor