Countryside Chiropractic Center PLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301008270 Issued in MI

Legal business name

COUNTRYSIDE CHIROPRACTIC CENTER PLC

Practice address

2100 S Clare Ave
Clare, MI 48617-9755

Phone

(989) 386-2931

Fax

(989) 386-3509

NPI assigned

Dec 23, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Lisa M Jaco, D.C

Title

Owner/President

Phone

(989) 386-2931

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Lisa Marie Jaco-Mitchell, D.C

  • Chiropractor
  • Clare, MI
  • NPI 1295719979
  NPD (past)

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

{
    "created_epoch": "1261526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261526400000",
    "number": "1053640912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 S CLARE AVE",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486179755",
            "telephone_number": "989-386-2931",
            "fax_number": "989-386-3509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S CLARE AVE",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486179755",
            "telephone_number": "989-386-2931",
            "fax_number": "989-386-3509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE CHIROPRACTIC CENTER PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-23",
        "last_updated": "2009-12-23",
        "status": "A",
        "authorized_official_last_name": "JACO",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "989-386-2931",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD OF MICHIGAN",
            "identifier": "0A850110",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4282720",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edith Clark, DPM
• Judith J Cline, R.PH.
• Jamie Lynn Clute, PTA
• Candace Comer
• Judith Ann Correll, MT
• Jessica Ann Curtis
• Timothy J Dailey
• Dale J Moser
• Stacy Lynn Davis, PTA
• Marc Alexander Dean, CRNA

• Chiropractor in Clare, MI
• Providers in Clare, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2009; 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.