Michael James Distler, DC, CCSP

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

38MC00760100 Issued in NJ

Practice address

56 N Haddon Ave Lowr Level
Haddonfield, NJ 08033-2438

Phone

(856) 240-7529

NPI assigned

Feb 5, 2011

Last updated

Nov 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16096/brand/2/csg/1/fhir/r4

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.

• South Jersey Spine & Sport LLC

  dba Sports Recovery Lab of Haddonfield

  • Chiropractor
  • Haddonfield, NJ
  • NPI 1497415160
  Authorized official Same address or phone
• Physio Logic Medicine, P.C.

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1013293588
  NPD

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

{
    "created_epoch": "1296864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1609172832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GREENVALE RD",
            "city": "MOORESTOWN",
            "state": "NJ",
            "postal_code": "080572234",
            "telephone_number": "203-241-4574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 N HADDON AVE LOWR LEVEL",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332438",
            "telephone_number": "856-240-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTLER",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "credential": "DC, CCSP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-05",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NI0900X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Internist",
            "state": "NY",
            "license": "N-A",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NJ",
            "license": "38MC00760100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher C Derivaux, M.D.
• Tara Deuso, BCBA
• Diagnostic &Professional Counseling
• Francesca Marcus Diefenbach
• Van Thien Dinh
• Doebler Foot and Ankle Specialists
• Colleen Donahue, PT, DPT
• Tammy Doyle, IBCLC
• Dr. Sandra Bwint
• Donald K Duffey, PHD PSYCHOLOGIST

• Sports Physician Chiropractor in Haddonfield, NJ
• Providers in Haddonfield, NJ by specialty
• Sports Physician Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; 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.