Kenneth Robert Tiller, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301005216 Issued in MI

Practice address

7890 Main
Birch Run, MI 48415

Phone

(989) 624-6266

Fax

(989) 624-4407

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Birch Run Chiropractic Clinic PLC

  • Chiropractor
  • Birch Run, MI
  • NPI 1609322486
  Medicare reassignment NPD Authorized official
• Gorges Life Chiropractic, LLC

  • Rehabilitation Chiropractor
  • Frankenmuth, MI
  • NPI 1548859549
  NPD

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278892800000",
    "number": "1093801201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "address_2": "7890 MAIN",
            "city": "BIRCH RUN",
            "state": "MI",
            "postal_code": "48415",
            "telephone_number": "989-624-6266",
            "fax_number": "989-624-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7890 MAIN",
            "city": "BIRCH RUN",
            "state": "MI",
            "postal_code": "48415",
            "telephone_number": "989-624-6266",
            "fax_number": "989-624-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLER",
        "first_name": "KENNETH",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2010-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301005216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2928135",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "391945651",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "950G35246",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Snellenberger, RPH
• Ashley Marie Stender, MA, NCC, LLC
• Christine Stevens, LMSW
• Jennifer Raquel Taylor-Perry, LPC
• Emily J Thompson, DDS
• Lauren Paige Tornberg
• Baleigh Ann Turner, MS, OTR/L
• Tabitha J Tyree
• Usv Optical Inc.
• Usv Optical, Inc.

• Chiropractor in Birch Run, MI
• Providers in Birch Run, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.