Function First Spine and Sport, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

FUNCTION FIRST SPINE AND SPORT, PLLC

Practice address

604 Sumner Ave
Humboldt, IA 50548-1761

Phone

(515) 570-7695

NPI assigned

May 13, 2021

Last updated

May 13, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cynthia S Vansickler, DC, CCSPNPI 1235495615

Title

Owner

Phone

(515) 570-7695

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

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.

• Cynthia Susanna Vansickler, D.C.

  • Chiropractor
  • Lakeville, MN
  • NPI 1235495615

  IA

  Medicare reassignment NPD Authorized official
• Kaitlyn Buckner, DC

  • Chiropractor
  • Neenah, WI
  • NPI 1366146391

  IA

  Medicare reassignment NPD

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620864000000",
    "number": "1407420664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1371 NELSON AVE",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505018534",
            "telephone_number": "525-570-7695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 SUMNER AVE",
            "city": "HUMBOLDT",
            "state": "IA",
            "postal_code": "505481761",
            "telephone_number": "515-570-7695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTION FIRST SPINE AND SPORT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "VANSICKLER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-570-7695",
        "authorized_official_credential": "DC, CCSP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235495615",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laine Dvorak, MD
• Early Chiropractic & Wellness, LLC (Humboldt Chiropractic)
• Harvey Frank Evans Jr.
• Lindy Flatau, PHARMD, RPH
• Jennifer Renee Forsberg, ARNP
• Ryan Dane Gidel, DDS
• Taylor Gidel, PA-C
• Gonnerman Chiropractic & Acupuncture PC
• Gary Gonnerman
• Larry James Hall, R.PH.

• Chiropractor in Humboldt, IA
• Providers in Humboldt, IA by specialty
• Chiropractor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; 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.