Fountain Chiro LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301009847 Issued in MI

Legal business name

FOUNTAIN CHIRO LLC

Practice address

24640 Telegraph Rd
Flat Rock, MI 48134-9226

Phone

(734) 782-0200

Fax

(734) 782-0200

NPI assigned

Oct 11, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Greg Ross FountainNPI 1033492756

Title

Owner

Phone

(734) 652-7259

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Greg Ross Fountain, D.C.

  • Chiropractor
  • Flat Rock, MI
  • NPI 1033492756
  Medicare reassignment NPD Authorized official
• Jason P Laske, DC

  • Chiropractor
  • Flat Rock, MI
  • NPI 1437192093
  Medicare reassignment NPD
• John H Florek, DC

  • Chiropractor
  • Flat Rock, MI
  • NPI 1720141930
  NPD (past)

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

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1013467323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24640 TELEGRAPH RD",
            "city": "FLAT ROCK",
            "state": "MI",
            "postal_code": "481349226",
            "telephone_number": "734-782-0200",
            "fax_number": "734-782-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24640 TELEGRAPH RD",
            "city": "FLAT ROCK",
            "state": "MI",
            "postal_code": "481349226",
            "telephone_number": "734-782-0200",
            "fax_number": "734-782-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN CHIRO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-11",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "FOUNTAIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-652-7259",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Flat Rock Cardiology PC
• Flat Rock Dental, P.C.
• Flat Rock Family Pharmacy LLC
• Flatrock City Pharmacy LLC
• John H Florek, DC
• Greg Ross Fountain, D.C.
• Taylor Frederick
• Matt A Gelso
• Fatima Hamadi, NP
• Lorel Hamilton

• Chiropractor in Flat Rock, MI
• Providers in Flat Rock, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.