Lisa Marie Jaco-Mitchell, D.C

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301008270 Issued in MI

Practice address

2100 S Clare Ave
Clare, MI 48617-9755

Phone

(989) 386-2931

Fax

(989) 386-3509

NPI assigned

Dec 6, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Chiropractic

Education

Sherman College of Straight Chiropractic, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Countryside Chiropractic Center PLC

  • Chiropractor
  • Clare, MI
  • NPI 1053640912
  NPD (past)

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1295719979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 S CLARE AVE",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486179755",
            "telephone_number": "989-386-2931",
            "fax_number": "989-386-3509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S CLARE AVE",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486179755",
            "telephone_number": "989-386-2931",
            "fax_number": "989-386-3509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACO-MITCHELL",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-06",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4282720",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "950A850110",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric William Houk, CRNA
• Maria Hovey, PA-C
• Patrick L Howe, DPT
• HPMG of Michigan, P.C. (Nurse Practitioners)
• Human Aid, Inc.
• Brandi Renee Jacobs, RN
• James Haines DDS PLLC
• Martin D Jennings, DO
• Amanda Jensen
• John a Finn OD PC

• Chiropractor in Clare, MI
• Providers in Clare, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.