Organization Active NPI

Structure and Function Chiropractic and Rehab PLC

  • Chiropractor
  • Traverse City, MI
National Provider Identifier
1306240627
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010258 Issued in MI
Legal business name
STRUCTURE AND FUNCTION CHIROPRACTIC AND REHAB PLC
Practice address
310 W Front St
Ste 310B
Traverse City, MI 49684-2279
Phone
(517) 320-2591
NPI assigned
Oct 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2014

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

Authorized official

Name
Dr. Donald Jay Funk, D.C.NPI 1750784765
Title
Member/Owner
Phone
(517) 320-2591

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 2301010258 MI Primary

Addresses

Primary practice location

310 W Front St
Ste 310B
Traverse City, MI 49684-2279

Mailing address

310 W Front St
Suite 310B
Traverse City, MI 49684-2279
Phone (517) 320-2591

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141112002200 MI Part B Supplier - Clinic/Group Practice 5698997351 Receives reassigned benefits from 3 practitioners
Practice locations: Traverse City, MI

National Provider Directory

National Provider Directory

Locations

310 W Front St
Ste 310B
Traverse City, MI 49684
Phone (517) 320-2591

120 Boardman Ave
Ste A
Traverse City, MI 49684
Phone (231) 421-3698

Practitioners & affiliated clinicians

Practitioners 6

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": "1413331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1306240627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W FRONT ST",
            "address_2": "SUITE 310B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842279",
            "telephone_number": "517-320-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W FRONT ST",
            "address_2": "STE 310B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842279",
            "telephone_number": "517-320-2591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRUCTURE AND FUNCTION CHIROPRACTIC AND REHAB PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-15",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "FUNK",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "517-320-2591",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.