Individual provider Active NPI

Stanley Allen Dombroski, DC

  • Chiropractor
  • Zeeland, MI
National Provider Identifier
1225009863
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
SD008737 Issued in MI
Practice address
300 S State St
Suite 4
Zeeland, MI 49464-1676
Phone
(616) 772-9255
Fax
(616) 772-9258
NPI assigned
Jan 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X SD008737 MI Primary

Addresses

Primary practice location

300 S State St
Suite 4
Zeeland, MI 49464-1676

Mailing address

300 S State St
Suite 4
Zeeland, MI 49464-1676
Phone (616) 772-9255

Other identifiers 1

IdentifierTypeStateIssuer
950G010840OtherMIBLUE CROSS BLUE SHIELD MI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040305000027 MI Practitioner - Chiropractic 5698662930 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2003
Medicare assignment
May accept Medicare assignment
Group practices
Balanced Health Chiropractic CenterGroup PAC ID 2466349774, 3 clinicians

Practice addresses (Care Compare)

300 S State St
Suite 4
Zeeland, MI 49464-1677

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SD008737MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Balanced Health Chiropractic Center Chiropractor CurrentSince Nov 1, 2003 Accepting new patients

Locations

300 S State St
Ste 4
Zeeland, MI 49464
Phone (616) 748-9700

Organizations & group practices 1

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": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1225009863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S STATE ST",
            "address_2": "SUITE 4",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494641676",
            "telephone_number": "616-772-9255",
            "fax_number": "616-772-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S STATE ST",
            "address_2": "SUITE 4",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494641676",
            "telephone_number": "616-772-9255",
            "fax_number": "616-772-9258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMBROSKI",
        "first_name": "STANLEY",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "SD008737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "950G010840",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Zeeland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; 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.