NPIMap

Organization Active NPI

Lakeshore Chiropractic and Sports Rehabilitation PLLC

  • Chiropractor
  • Charlevoix, MI
National Provider Identifier
1184881344
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301004616 Issued in MI
Legal business name
LAKESHORE CHIROPRACTIC AND SPORTS REHABILITATION PLLC
Practice address
1302 Bridge St
Charlevoix, MI 49720-1608
Phone
(231) 237-0665
Fax
(231) 237-0672
NPI assigned
May 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

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

Authorized official

Name
Dr. Aaron Wilkin, DCNPI 1972790525
Title
Owner
Phone
(231) 237-0665

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 2301004616 MI Primary

Addresses

Primary practice location

1302 Bridge St
Charlevoix, MI 49720-1608

Mailing address

1302 Bridge St
Charlevoix, MI 49720-1608
Phone (231) 237-0665

Other identifiers 3

IdentifierTypeStateIssuer
1408604MedicaidMI
950A510420OtherMIBCBSM OF MICHIGAN
950A550050OtherMIBCBS

Other names 1

  • Randall 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
O20181102002304 MI Part B Supplier - Clinic/Group Practice 1658624937 Receives reassigned benefits from 2 practitioners
Practice locations: Charlevoix, MI

National Provider Directory

National Provider Directory

Locations

1302 Bridge St
Charlevoix, MI 49720
Phone (231) 237-0665

Practitioners & affiliated clinicians

Practitioners 2

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": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1184881344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 BRIDGE ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201608",
            "telephone_number": "231-237-0665",
            "fax_number": "231-237-0672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 BRIDGE ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201608",
            "telephone_number": "231-237-0665",
            "fax_number": "231-237-0672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE CHIROPRACTIC AND SPORTS REHABILITATION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2018-10-10",
        "status": "A",
        "authorized_official_last_name": "WILKIN",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-237-0665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301004616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1408604",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM OF MICHIGAN",
            "identifier": "950A510420",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "950A550050",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randall Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Randall Chiropractic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlevoix, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; 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.