NPIMap

Organization Active NPI

Independence Health, PLLC

  • Chiropractor
  • Kentwood, MI
National Provider Identifier
1306200431
Registry record updated Apr 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010330 Issued in MI
Legal business name
INDEPENDENCE HEALTH, PLLC
Practice address
5360 Eastern Ave SE
Kentwood, MI 49508-6018
Phone
(616) 427-3077
Fax
(616) 323-0773
NPI assigned
Apr 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

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

Authorized official

Name
Robin Niezgoda, DCNPI 1548626484
Title
Owner
Phone
(616) 427-3077

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 2301010330 MI Primary

Addresses

Primary practice location

5360 Eastern Ave SE
Kentwood, MI 49508-6018

Mailing address

5360 Eastern Ave SE
Kentwood, MI 49508-6018
Phone (616) 427-3077

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260127002600 MI Part B Supplier - Clinic/Group Practice 6002393592 Receives reassigned benefits from 2 practitioners
Practice locations: Kalamazoo, MI

National Provider Directory

National Provider Directory
Tax ID family
Health Choice Chiropractic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5360 Eastern Ave SE
Kentwood, MI 49508
Phone (616) 427-3077

Practitioners & affiliated clinicians

Practitioners 2

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": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1306200431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5360 EASTERN AVE SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495086018",
            "telephone_number": "616-427-3077",
            "fax_number": "616-323-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5360 EASTERN AVE SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495086018",
            "telephone_number": "616-427-3077",
            "fax_number": "616-323-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "NIEZGODA",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-427-3077",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.