Individual provider Active NPI

Nikola Andreev, DC

  • Chiropractor
  • Walled Lake, MI
National Provider Identifier
1194305573
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301011104 Issued in MI
Practice address
547 N Pontiac TRL
Walled Lake, MI 48390-3442
Phone
(248) 560-7971
NPI assigned
Apr 10, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301011104 MI Primary

Addresses

Primary practice location

547 N Pontiac TRL
Walled Lake, MI 48390-3442

Mailing address

547 N Pontiac TRL
Walled Lake, MI 48390-3442
Phone (248) 560-7971

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220129000138 MI Practitioner - Chiropractic 5395138184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Sherman College of Straight Chiropractic, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

547 N Pontiac TRL
Walled Lake, MI 48390-3442
Phone (248) 560-7971

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301011104MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Family Chiropractic & Wellness PLLC Chiropractor CurrentSince Jan 24, 2022 Accepting new patients
Unity Chiropractic PLC Chiropractor PastSince Apr 1, 2021 Accepting new patients

Locations

547 N Pontiac Trl
Walled Lake, MI 48390
Phone (248) 560-7971

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1618012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1194305573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "547 N PONTIAC TRL",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903442",
            "telephone_number": "248-560-7971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "547 N PONTIAC TRL",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903442",
            "telephone_number": "248-560-7971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDREEV",
        "first_name": "NIKOLA",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-10",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301011104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walled Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; 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.