Great Lakes Sport and Spine

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

GREAT LAKES SPORT AND SPINE

Practice address

34940 Ridge Rd Ste B
Willoughby, OH 44094-4197

Phone

(440) 503-6683

NPI assigned

Jun 12, 2023

Organization subpart

No

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

Authorized official

Name

Matthew Paul Martin, DCNPI 1205132032

Title

Owner

Phone

(440) 503-6683

Specialties & licenses 2

Addresses

Practitioners 1

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

• Matthew Paul Martin, D.C.

  • Chiropractor
  • Willoughby, OH
  • NPI 1205132032
  NPD Authorized official

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1104500925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34940 RIDGE RD STE B",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944197",
            "telephone_number": "440-503-6683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34940 RIDGE RD STE B",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944197",
            "telephone_number": "440-503-6683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SPORT AND SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-503-6683",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antionette Graham
• Briyanna Graham
• Deannette Marshe Grant
• Stephanie Grantz
• Karen Larkins Graves, LPCC-S, LICDC
• Great Lakes Sports & Spine LLC
• Adrienne Elizabeth Green, LISW
• Katie Lauren Greenaway, RN
• Jordan Jamere Greene
• David Greenhoff, LPN

• Chiropractor in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.