Individual provider Active NPI

John G Bloodworth, D.O.

  • Chiropractor
  • Sterling HTS, MI
National Provider Identifier
1104866730
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301007508 Issued in MI
Practice address
4105 Metropolitan Pkwy
Suite 101
Sterling HTS, MI 48310-7503
Phone
(586) 939-1003
Fax
(586) 939-3862
NPI assigned
Jun 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301007508 MI Primary

Addresses

Primary practice location

4105 Metropolitan Pkwy
Suite 101
Sterling HTS, MI 48310-7503

Mailing address

4105 Metropolitan Pkwy
Suite 101
Sterling HTS, MI 48310-7503
Phone (586) 939-1003

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)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
New Leaf Chiropractic, LLC Chiropractor CurrentSince Sep 13, 2022 Accepting new patients

Locations

4105 Metropolitan Pkwy
Ste 101
Sterling Hts, MI 48310
Phone (586) 939-1003

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.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104866730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 METROPOLITAN PKWY",
            "address_2": "SUITE 101",
            "city": "STERLING HTS",
            "state": "MI",
            "postal_code": "483107503",
            "telephone_number": "586-939-1003",
            "fax_number": "586-939-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 METROPOLITAN PKWY",
            "address_2": "SUITE 101",
            "city": "STERLING HTS",
            "state": "MI",
            "postal_code": "483107503",
            "telephone_number": "586-939-1003",
            "fax_number": "586-939-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOODWORTH",
        "first_name": "JOHN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301007508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling HTS, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.