Individual provider Active NPI

Jean Mikula, D.C.

  • Chiropractor
  • Grand Rapids, MI
National Provider Identifier
1457388142
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301007184 Issued in MI
Practice address
4056 Plainfield Ave NE
Ste. E
Grand Rapids, MI 49525-1630
Phone
(616) 365-0255
Fax
(616) 365-0975
NPI assigned
Jun 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301007184 MI Primary

Addresses

Primary practice location

4056 Plainfield Ave NE
Ste. E
Grand Rapids, MI 49525-1630

Mailing address

4029 Plainfield Ave NE
# B
Grand Rapids, MI 49525-1628
Phone (616) 365-0255

Other identifiers 1

IdentifierTypeStateIssuer
3269896MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080924000214 MI Practitioner - Chiropractic 4284701863 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Sherman College of Straight Chiropractic, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mikula Chiropractic, P.C.Group PAC ID 4486721479, 2 clinicians

Practice addresses (Care Compare)

4029 Plainfield Ave NE
Grand Rapids, MI 49525-1628
Phone (616) 365-0255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301007184MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Mikula Chiropractic, P.C. Chiropractor CurrentSince Jan 16, 2007 Accepting new patients
Mikula Chiropractic Center Chiropractor Past Accepting new patients

Locations

4029 Plainfield Ave NE
Grand Rapids, MI 49525
Phone (616) 365-0255

4029 Plainfield Ave NE
Ste B
Grand Rapids, MI 49525

4056 Plainfield Ave NE
Ste E
Grand Rapids, MI 49525
Phone (616) 365-0255

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1457388142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4029 PLAINFIELD AVE NE",
            "address_2": "# B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251628",
            "telephone_number": "616-365-0255",
            "fax_number": "616-365-0975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4056 PLAINFIELD AVE NE",
            "address_2": "STE. E",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251630",
            "telephone_number": "616-365-0255",
            "fax_number": "616-365-0975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKULA",
        "first_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301007184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3269896",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.