NPIMap

Organization Active NPI

Kooistra Chiropractic Clinic PLLC

  • Chiropractor
  • Wyoming, MI
National Provider Identifier
1396018446
Registry record updated Feb 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1496 Issued in MI
Legal business name
KOOISTRA CHIROPRACTIC CLINIC PLLC
Practice address
2855 Byron Center Ave SW
Wyoming, MI 49519-2415
Phone
(616) 532-2518
Fax
(616) 532-2696
NPI assigned
Feb 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2012

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

Authorized official

Name
Dr. C Scott Kooistra, D.C.
Title
Doctor of Chiropractic
Phone
(616) 532-2518

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 1496 MI Primary

Addresses

Primary practice location

2855 Byron Center Ave SW
Wyoming, MI 49519-2415

Mailing address

2855 Byron Center Ave SW
Wyoming, MI 49519-2415
Phone (616) 532-2518

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120427000138 MI Part B Supplier - Clinic/Group Practice 0042472672 Receives reassigned benefits from 8 practitioners
Practice locations: Grand Rapids, MI; Wyoming, MI

National Provider Directory

National Provider Directory

Locations

1680 East Paris Ave SE
Grand Rapids, MI 49546
Phone (231) 631-4628

2855 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 532-2518

Practitioners & affiliated clinicians

Practitioners 9

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": "1329782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1396018446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495192415",
            "telephone_number": "616-532-2518",
            "fax_number": "616-532-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495192415",
            "telephone_number": "616-532-2518",
            "fax_number": "616-532-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOISTRA CHIROPRACTIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-21",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "KOOISTRA",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "616-532-2518",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "1496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; 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.