NPIMap

Organization Active NPI

Genesis Chiropractic, LLC

Doing business as ProActive Chiropractic

  • Chiropractor
  • Festus, MO
National Provider Identifier
1144708975
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2001008726 Issued in MO
Legal business name
GENESIS CHIROPRACTIC, LLC
Doing business as
ProActive Chiropractic
Practice address
1520 Parkway W
Festus, MO 63028-2381
Phone
(636) 937-0100
NPI assigned
Aug 2, 2018
Last updated
Jan 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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

Authorized official

Name
Dr. Lynette Renee Mayfield, DCNPI 1457436560
Title
Owner
Phone
(314) 210-2623

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
Chiropractor 111N00000X 2001008726 MO Primary

Addresses

Primary practice location

1520 Parkway W
Festus, MO 63028-2381

Mailing address

101 Richardson Xing
Arnold, MO 63010-6006
Phone (314) 210-2623

Other names 1

  • ProActive Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181219002056 MO Part B Supplier - Clinic/Group Practice 7810232808 Receives reassigned benefits from 3 practitioners
Practice locations: Festus, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1533168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547596800000",
    "number": "1144708975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 RICHARDSON XING",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "630106006",
            "telephone_number": "314-210-2623",
            "fax_number": "636-464-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 PARKWAY W",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630282381",
            "telephone_number": "636-937-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-02",
        "last_updated": "2019-01-16",
        "status": "A",
        "authorized_official_last_name": "MAYFIELD",
        "authorized_official_first_name": "LYNETTE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-210-2623",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2001008726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProActive Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProActive Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Festus, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; 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.