Active NPI
Jan Gagnon, ND
- Behavior Technician
- Novi, MI
National Provider Identifier
1063931970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 41521 W 11 Mile Rd
Novi, MI 48375-1803 - Phone
- (248) 299-0030
- NPI assigned
- Sep 12, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Naturopath | 175F00000X | 00000518 | WA | |
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
41521 W 11 Mile Rd
Novi, MI 48375-1803
Mailing address
12503 SE Mill Plain Blvd # 215a
Vancouver, WA 98684-4009
Phone (360) 448-6353
Other practice location 1
12503 SE Mill Plain Blvd
#215A
Vancouver, WA 98684
Phone (360) 448-6353
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00000518 | WA | MD | Naturopath |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Contemporary Chiropractic PS | 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
- Vancouver, WA
- NPI 1033341128
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1063931970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12503 SE MILL PLAIN BLVD # 215A",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986844009",
"telephone_number": "360-448-6353",
"fax_number": "360-859-3784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41521 W 11 MILE RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483751803",
"telephone_number": "248-299-0030"
}
],
"practiceLocations": [
{
"address_1": "12503 SE Mill Plain Blvd",
"address_2": "#215A",
"address_purpose": "LOCATION",
"city": "Vancouver",
"state": "WA",
"postal_code": "98684",
"country_code": "US",
"telephone_number": "360-448-6353",
"fax_number": "360-859-3784",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GAGNON",
"first_name": "JAN",
"name_prefix": "Dr.",
"credential": "ND",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-12",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "175F00000X",
"taxonomy_group": "",
"desc": "Naturopath",
"state": "WA",
"license": "00000518",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.