NPIMap

Organization Active NPI

Summit Family Chiropractic

  • Chiropractor
  • Coeur d'Alene, ID
National Provider Identifier
1295012623
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA1447 Issued in ID
Legal business name
SUMMIT FAMILY CHIROPRACTIC
Doing business as
Summit Family Chiropractic
Practice address
2634 N Government Way
Coeur D Alene, ID 83815-3750
Phone
(208) 771-4474
Fax
(208) 664-1001
NPI assigned
Nov 14, 2011
Last updated
Dec 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

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

Authorized official

Name
Ryan Sousley, DCNPI 1144507575
Title
Chiropractic
Phone
(208) 771-4474

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
Chiropractor 111N00000X CHIA1447 ID Primary

Addresses

Primary practice location

2634 N Government Way
Coeur D Alene, ID 83815-3750

Mailing address

2634 N Government Way
Coeur D Alene, ID 83815-3750
Phone (208) 771-4474

Other names 1

  • Summit Family Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120320000314 ID Part B Supplier - Clinic/Group Practice 3870753437 Receives reassigned benefits from 6 practitioners
Practice locations: Coeur D Alene, ID; Post Falls, ID

National Provider Directory

National Provider Directory

Locations

2634 N Government Way
Coeur D Alene, ID 83815
Phone (208) 664-1000

1590 E Seltice Way
Ste 101
Post Falls, ID 83854
Phone (208) 981-3500

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482105600000",
    "number": "1295012623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2634 N GOVERNMENT WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838153750",
            "telephone_number": "208-771-4474",
            "fax_number": "208-664-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2634 N GOVERNMENT WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838153750",
            "telephone_number": "208-771-4474",
            "fax_number": "208-664-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT FAMILY CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2016-12-19",
        "status": "A",
        "authorized_official_last_name": "SOUSLEY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIROPRACTIC",
        "authorized_official_telephone_number": "208-771-4474",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA1447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; 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.