Individual provider Active NPI

Coleman John Koons, DC

  • Chiropractor
  • Mitchell, SD
National Provider Identifier
1609551340
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1465 Issued in SD
Practice address
1415 W Havens Ave Ste 3
Mitchell, SD 57301-4105
Phone
(605) 996-1160
Fax
(605) 996-6433
NPI assigned
Jun 20, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1465 SD Primary

Addresses

Primary practice location

1415 W Havens Ave Ste 3
Mitchell, SD 57301-4105

Mailing address

1415 W Havens Ave Ste 3
Mitchell, SD 57301-4105
Phone (605) 996-1160

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230818001646 SD Practitioner - Chiropractic 8224490438 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chiropractic Center for Healthy Living PCGroup PAC ID 7012977648, 3 clinicians

Practice addresses (Care Compare)

1415 W Havens Ave
Suite 3
Mitchell, SD 57301-4105
Phone (605) 996-1160

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Center for Healthy Living PC Chiropractor CurrentSince Aug 7, 2023 Accepting new patients
Dobesh Chiropractic Prof LLC Chiropractor PastSince Jun 25, 2023 Accepting new patients

Locations

1415 W Havens Ave
Ste 3
Mitchell, SD 57301
Phone (605) 996-1160

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, 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": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1609551340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 W HAVENS AVE STE 3",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573014105",
            "telephone_number": "605-996-1160",
            "fax_number": "605-996-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 W HAVENS AVE STE 3",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573014105",
            "telephone_number": "605-996-1160",
            "fax_number": "605-996-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONS",
        "first_name": "COLEMAN",
        "middle_name": "JOHN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SD",
            "license": "1465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mitchell, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; 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.