Active NPI
Timothy Grondin, CHIROPRACTOR
- Chiropractor
- Port Huron, MI
National Provider Identifier
1023067618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2301006814
- Practice address
- 1831 Pine Grove Ave
Port Huron, MI 48060-3120 - Phone
- (810) 984-3344
- NPI assigned
- May 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2301006814 | MI | Primary |
Addresses
Primary practice location
1831 Pine Grove Ave
Port Huron, MI 48060-3120
Mailing address
1831 Pine Grove Ave
Port Huron, MI 48060-3120
Phone (810) 984-3344
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 950G45010 | Other | MI | BC/BS PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2301006814 | MI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Skylar Bakko PLLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Marysville, MI
- NPI 1881436749
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023067618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1831 PINE GROVE AVE",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603120",
"telephone_number": "810-984-3344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1831 PINE GROVE AVE",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603120",
"telephone_number": "810-984-3344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRONDIN",
"first_name": "TIMOTHY",
"credential": "CHIROPRACTOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MI",
"license": "2301006814",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS PROVIDER NUMBER",
"identifier": "950G45010",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.