Provider Demographics
NPI:1295879427
Name:TILTON, TRENT M (DC)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:M
Last Name:TILTON
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 1:6820 OLD 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6926
Mailing Address - Country:US
Mailing Address - Phone:616-949-1888
Mailing Address - Fax:616-949-9602
Practice Address - Street 1:6820 OLD 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6926
Practice Address - Country:US
Practice Address - Phone:616-949-1888
Practice Address - Fax:616-949-9602
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor