Individual provider Active NPI

Bryce D Koelling, D.C.

  • Chiropractor
  • Fulton, MO
National Provider Identifier
1568419596
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6746 Issued in MO
Practice address
621 Commons Dr
Fulton, MO 65251
Phone
(573) 642-2273
Fax
(573) 642-1900
NPI assigned
May 27, 2006
Last updated
Sep 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6746 MO Primary

Addresses

Primary practice location

621 Commons Dr
Fulton, MO 65251

Mailing address

621 Commons Dr
Fulton, MO 65251-1489
Phone (573) 642-2273

Other practice location 1

605 Nichols St
Fulton, MO 65251-2650
Phone (572) 642-2273

Other practice location 2

621 Commons Dr
Fulton, MO 65251
Phone (573) 642-2273

Other practice location 3

3702 W Truman Blvd Ste 218
Jefferson City, MO 65109-4970
Phone (573) 606-6970

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080625000208 MO Practitioner - Chiropractic 9739250366 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Koelling Family Chiropractic JeffcityGroup PAC ID 6406198209, 4 clinicians
Koelling Family Chiropractic PCGroup PAC ID 4183795719, 4 clinicians

Practice addresses (Care Compare)

3702 W Truman Blvd
Suite 218
Jefferson City, MO 65109-6153
Phone (573) 310-9391

621 Commons Dr
Fulton, MO 65251-1489
Phone (573) 642-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6746MOMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Koelling Family Chiropractic, PC Chiropractor CurrentSince Mar 1, 1999 Accepting new patients
Koelling Family Chiropractic Jeffcity Chiropractor CurrentSince Jan 10, 2019 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

605 Nichols St
Fulton, MO 65251
Phone (572) 642-2273

621 Commons Dr
Fulton, MO 65251
Phone (573) 642-2273

3702 W Truman Blvd
Ste 218
Jefferson City, MO 65109
Phone (573) 310-9391

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1568419596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 COMMONS DR",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652511489",
            "telephone_number": "573-642-2273",
            "fax_number": "573-642-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 COMMONS DR",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "65251",
            "telephone_number": "573-642-2273",
            "fax_number": "573-642-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "605 Nichols St",
            "address_purpose": "LOCATION",
            "city": "Fulton",
            "state": "MO",
            "postal_code": "652512650",
            "country_code": "US",
            "telephone_number": "572-642-2273",
            "fax_number": "573-642-1900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "621 Commons Dr",
            "address_purpose": "LOCATION",
            "city": "Fulton",
            "state": "MO",
            "postal_code": "65251",
            "country_code": "US",
            "telephone_number": "573-642-2273",
            "fax_number": "573-642-1900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3702 W Truman Blvd Ste 218",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "MO",
            "postal_code": "651094970",
            "country_code": "US",
            "telephone_number": "573-606-6970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOELLING",
        "first_name": "BRYCE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "6746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; 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.