Michael John Modich, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5322 Issued in MN

Practice address

7636 Pine Tree Rd
Side Lake, MN 55781-8441

Phone

(218) 969-4928

NPI assigned

Oct 14, 2010

Last updated

Oct 14, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Range Spine Center, PLLCGroup PAC ID 2062666597, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Range Spine Center, PLLC

  • Chiropractor
  • Hibbing, MN
  • NPI 1720338676
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1287014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287014400000",
    "number": "1114237013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7636 PINE TREE RD",
            "city": "SIDE LAKE",
            "state": "MN",
            "postal_code": "557818441",
            "telephone_number": "218-969-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7636 PINE TREE RD",
            "city": "SIDE LAKE",
            "state": "MN",
            "postal_code": "557818441",
            "telephone_number": "218-969-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODICH",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-14",
        "last_updated": "2010-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randy C. Asman, M.D.
• Pamela G Lubina

• Chiropractor in Side Lake, MN
• Providers in Side Lake, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.