Organization Active NPI

Koelling Family Chiropractic, PC

  • Chiropractor
  • Fulton, MO
National Provider Identifier
1194985267
Registry record updated Jul 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6746 Issued in MO
Legal business name
KOELLING FAMILY CHIROPRACTIC, PC
Practice address
621 Commons Drive
Fulton, MO 65251-2650
Phone
(573) 642-2273
Fax
(573) 642-1900
NPI assigned
Jun 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2015

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

Authorized official

Name
Dr. Bryce D Koelling, DCNPI 1568419596
Title
Owner
Phone
(573) 642-2273

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 6746 MO Primary

Addresses

Primary practice location

621 Commons Drive
Fulton, MO 65251-2650

Mailing address

621 Commons Dr
Fulton, MO 65251-1489
Phone (573) 642-2273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080625000216 MO Part B Supplier - Clinic/Group Practice 4183795719 Receives reassigned benefits from 5 practitioners
Practice locations: Fulton, MO

National Provider Directory

National Provider Directory

Locations

605 Nichols St
Fulton, MO 65251
Phone (572) 642-2273

621 Commons Dr
Fulton, MO 65251
Phone (573) 642-2273

Practitioners & affiliated clinicians

Practitioners 6

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": "1213228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438041600000",
    "number": "1194985267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 COMMONS DR",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652511489",
            "telephone_number": "573-642-2273",
            "fax_number": "573-642-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 COMMONS DRIVE",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512650",
            "telephone_number": "573-642-2273",
            "fax_number": "573-642-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOELLING FAMILY CHIROPRACTIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-12",
        "last_updated": "2015-07-28",
        "status": "A",
        "authorized_official_last_name": "KOELLING",
        "authorized_official_first_name": "BRYCE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-642-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "6746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; 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.