NPIMap

Organization Active NPI

Structure & Function

  • Chiropractor
  • Plymouth, MI
National Provider Identifier
1033563242
Registry record updated May 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010368 Issued in MI
Legal business name
STRUCTURE & FUNCTION
Practice address
595 Forest Ave
Suite- 7B
Plymouth, MI 48170-1775
Phone
(734) 335-3635
Fax
(734) 212-2270
NPI assigned
Apr 14, 2016
Last updated
May 31, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2016

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

Authorized official

Name
Dr. Otto Albert Geiseman IV, D.CNPI 1033546197
Title
Chiropractor
Phone
(248) 497-1034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301010368 MI Primary

Addresses

Primary practice location

595 Forest Ave
Suite- 7B
Plymouth, MI 48170-1775

Mailing address

595 Forest Ave
Suite- 7B
Plymouth, MI 48170-1775
Phone (734) 335-3635

National Provider Directory

National Provider Directory

Locations

595 Forest Ave
Ste 7B
Plymouth, MI 48170
Phone (734) 335-3635

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1033563242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 FOREST AVE",
            "address_2": "SUITE- 7B",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701775",
            "telephone_number": "734-335-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 FOREST AVE",
            "address_2": "SUITE- 7B",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701775",
            "telephone_number": "734-335-3635",
            "fax_number": "734-212-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRUCTURE & FUNCTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-14",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "GEISEMAN",
        "authorized_official_first_name": "OTTO",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "248-497-1034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; 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.