Active NPI
Marc Karl Mavis, DC
- Chiropractor
- Saint Joseph, MI
National Provider Identifier
1215014139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2301004976
- Practice address
- 2550 Niles Rd
St Joseph, MI 49085 - Phone
- (269) 429-5727
- Fax
- (269) 429-5766
- NPI assigned
- Nov 1, 2006
- Last updated
- Nov 17, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2301004976 | MI | Primary |
Addresses
Primary practice location
2550 Niles Rd
St Joseph, MI 49085
Mailing address
2550 Niles Rd
Mavis Chiropractic Center
St Joseph, MI 49085
Phone (269) 429-5727
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 950A150130 | Other | MI | BCBS MI |
| 2301004976 | Other | MI | MI LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2550 Niles Rd
Saint Joseph, MI 49085-3270
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2301004976 | MI | MD | Chiropractor |
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.
-
- Chiropractor
- Saint Joseph, MI
- NPI 1689460354
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321488000000",
"number": "1215014139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 NILES RD",
"address_2": "MAVIS CHIROPRACTIC CENTER",
"city": "ST JOSEPH",
"state": "MI",
"postal_code": "49085",
"telephone_number": "269-429-5727",
"fax_number": "269-429-5766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 NILES RD",
"city": "ST JOSEPH",
"state": "MI",
"postal_code": "49085",
"telephone_number": "269-429-5727",
"fax_number": "269-429-5766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAVIS",
"first_name": "MARC",
"middle_name": "KARL",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2011-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MI",
"license": "2301004976",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MI",
"identifier": "950A150130",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MI LICENSE",
"identifier": "2301004976",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Joseph, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; 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.