NPIMap

Organization Active NPI

Novo Chiropractic PLLC

  • Chiropractor
  • Wyoming, MI
National Provider Identifier
1417328659
Registry record updated Oct 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010372 Issued in MI
Legal business name
NOVO CHIROPRACTIC PLLC
Practice address
5570 Wilson Ave SW
Ste L
Wyoming, MI 49418-8867
Phone
(616) 259-9835
NPI assigned
Oct 14, 2015
Last updated
Oct 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2015

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

Authorized official

Name
Dr. Joshua P Konynenbelt, D.C., M.S.NPI 1710357504
Title
Clinic Director
Phone
(616) 259-9835

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301010340 MI
Chiropractor 111N00000X 2301010372 MI Primary

Addresses

Primary practice location

5570 Wilson Ave SW
Ste L
Wyoming, MI 49418-8867

Mailing address

5570 Wilson Ave SW
Ste L
Wyoming, MI 49418-8867
Phone (616) 259-9835

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170125000246 MI Part B Supplier - Clinic/Group Practice 5991087041 Receives reassigned benefits from 11 practitioners
Practice locations: Belmont, MI; Grand Rapids, MI; Jenison, MI; Wyoming, MI

National Provider Directory

National Provider Directory

Locations

4551 Cascade Rd SE
Ste A
Grand Rapids, MI 49546
Phone (616) 942-8770

1915 Georgetown Center Dr
Ste 103
Jenison, MI 49428
Phone (616) 233-5483

5570 Wilson Ave SW
Ste L
Wyoming, MI 49418
Phone (616) 259-9835

5570 Wilson Ave SW
Ste Mn
Wyoming, MI 49418
Phone (616) 259-9835

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1417328659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5570 WILSON AVE SW",
            "address_2": "STE L",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "494188867",
            "telephone_number": "616-259-9835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5570 WILSON AVE SW",
            "address_2": "STE L",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "494188867",
            "telephone_number": "616-259-9835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVO CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-14",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "KONYNENBELT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "616-259-9835",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., M.S."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010340",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010372",
            "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 Oct 14, 2015; 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.