NPIMap

Organization Active NPI

Crystal Lake Chiropractic, PLC

  • Chiropractor
  • Benzonia, MI
National Provider Identifier
1053691618
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301007090 Issued in MI
Legal business name
CRYSTAL LAKE CHIROPRACTIC, PLC
Practice address
6635 North St
Benzonia, MI 49616-9765
Phone
(231) 882-5533
Fax
(231) 882-1361
NPI assigned
Aug 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

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

Authorized official

Name
Dr. Janine Felice-Johnson, D.C.
Title
President
Phone
(231) 882-5533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2301007090 MI Primary

Addresses

Primary practice location

6635 North St
Benzonia, MI 49616-9765

Mailing address

6635 North St
Benzonia, MI 49616-9765
Phone (231) 882-5533

Other identifiers 1

IdentifierTypeStateIssuer
950A010070OtherMIBCBS

National Provider Directory

National Provider Directory

Locations

6635 North St
Benzonia, MI 49616
Phone (231) 882-5533

NPI Registry JSON

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

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1053691618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6635 NORTH ST",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496169765",
            "telephone_number": "231-882-5533",
            "fax_number": "231-882-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6635 NORTH ST",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496169765",
            "telephone_number": "231-882-5533",
            "fax_number": "231-882-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE CHIROPRACTIC, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-26",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "FELICE-JOHNSON",
        "authorized_official_first_name": "JANINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-882-5533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301007090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "950A010070",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benzonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; 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.