NPIMap

Organization Active NPI

Life Cycle Family Chiropractic, PC

  • Chiropractor
  • Milan, MI
National Provider Identifier
1336280817
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301008349 Issued in MI
Legal business name
LIFE CYCLE FAMILY CHIROPRACTIC, PC
Practice address
1162 Dexter St
Milan, MI 48160-1162
Phone
(734) 439-0100
Fax
(734) 439-7701
NPI assigned
Feb 9, 2007
Last updated
Jan 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

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

Authorized official

Name
Dr. James Matthew Wagner, D.C.NPI 1851379044
Title
Owner
Phone
(734) 439-0100

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 2301008349 MI Primary

Addresses

Primary practice location

1162 Dexter St
Milan, MI 48160-1162

Mailing address

1162 Dexter St
Milan, MI 48160-1162
Phone (734) 439-0100

Other identifiers 3

IdentifierTypeStateIssuer
12317OtherMIMCARE
95-0-H1-1336-0OtherMIBCBS
OH 13360OtherMIBCN

National Provider Directory

National Provider Directory

Locations

1162 Dexter St
Milan, MI 48160
Phone (734) 439-0100

529 W Main St
Milan, MI 48160
Phone (734) 439-0100

Practitioners & affiliated clinicians

Practitioners 2

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": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1336280817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162 DEXTER ST",
            "city": "MILAN",
            "state": "MI",
            "postal_code": "481601162",
            "telephone_number": "734-439-0100",
            "fax_number": "734-439-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1162 DEXTER ST",
            "city": "MILAN",
            "state": "MI",
            "postal_code": "481601162",
            "telephone_number": "734-439-0100",
            "fax_number": "734-439-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CYCLE FAMILY CHIROPRACTIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-439-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "12317",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "95-0-H1-1336-0",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "OH 13360",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milan, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.