NPIMap

Organization Active NPI

Robert Edward Potter Jr DC PLLC

  • Chiropractor
  • Canton, MI
National Provider Identifier
1114919016
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301005410 Issued in MI
Legal business name
ROBERT EDWARD POTTER JR DC PLLC
Practice address
6231 N Canton Center Rd
Suite 109
Canton, MI 48187-2694
Phone
(734) 455-6767
Fax
(734) 455-2359
NPI assigned
Aug 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert Edward Potter Jr., DCNPI 1649262254
Title
Owner
Phone
(734) 455-6767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2301005410 MI Primary

Addresses

Primary practice location

6231 N Canton Center Rd
Suite 109
Canton, MI 48187-2694

Mailing address

6231 N Canton Center Rd
Suite 109
Canton, MI 48187-2694
Phone (734) 455-6767

Other names 1

  • Canton Center Chiropractic Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060410000312 MI Part B Supplier - Clinic/Group Practice 3476562059 Receives reassigned benefits from 5 practitioners
Practice locations: Canton, MI

National Provider Directory

National Provider Directory

Locations

6231 N Canton Center Rd
Canton, MI 48187
Phone (734) 455-6767

6231 N Canton Center Rd
Ste 109
Canton, MI 48187
Phone (734) 455-6767

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114919016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6231 N CANTON CENTER RD",
            "address_2": "SUITE 109",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872694",
            "telephone_number": "734-455-6767",
            "fax_number": "734-455-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6231 N CANTON CENTER RD",
            "address_2": "SUITE 109",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872694",
            "telephone_number": "734-455-6767",
            "fax_number": "734-455-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT EDWARD POTTER JR DC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-455-6767",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301005410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canton Center Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.