NPIMap

Organization Active NPI

Van Buren Chiropractic Clinic, P.C.

  • Chiropractor
  • Paw Paw, MI
National Provider Identifier
1144234451
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301004320 Issued in MI
Legal business name
VAN BUREN CHIROPRACTIC CLINIC, P.C.
Practice address
309 S Kalamazoo St
Paw Paw, MI 49079-1527
Phone
(269) 657-7005
Fax
(269) 657-7007
NPI assigned
Jul 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Dr. Raymond Charles Tattersall, D.C.NPI 1750460721
Title
Owner
Phone
(269) 657-7005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2301004320 MI Primary

Addresses

Primary practice location

309 S Kalamazoo St
Paw Paw, MI 49079-1527

Mailing address

309 S Kalamazoo St
Paw Paw, MI 49079-1527
Phone (269) 657-7005

Other identifiers 7

IdentifierTypeStateIssuer
16123OtherMIMCARE PIN
44-30051OtherMIIBA/PHP NUMBER
2301004320OtherMILICENSE NUMBER
P67311OtherMIBLUE CARE NETWORK PIN
1935037MedicaidMI
RT004320OtherMIBCBS PIN
950H05002OtherMIBCBS MICHIGAN

National Provider Directory

National Provider Directory

Locations

309 S Kalamazoo St
Paw Paw, MI 49079
Phone (269) 657-7005

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144234451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 S KALAMAZOO ST",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791527",
            "telephone_number": "269-657-7005",
            "fax_number": "269-657-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S KALAMAZOO ST",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791527",
            "telephone_number": "269-657-7005",
            "fax_number": "269-657-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN BUREN CHIROPRACTIC CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TATTERSALL",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-657-7005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301004320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE PIN",
            "identifier": "16123",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBA/PHP NUMBER",
            "identifier": "44-30051",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "2301004320",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK PIN",
            "identifier": "P67311",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1935037",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "RT004320",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MICHIGAN",
            "identifier": "950H05002",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paw Paw, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.