NPIMap

Organization Active NPI

West Branch Chiropractic Center, PC

  • Chiropractor
  • West Branch, MI
National Provider Identifier
1629273743
Registry record updated Mar 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DM007681 Issued in MI
Legal business name
WEST BRANCH CHIROPRACTIC CENTER, PC
Practice address
110 E Houghton Ave
West Branch, MI 48661-1124
Phone
(989) 345-3310
Fax
(989) 345-6610
NPI assigned
Jun 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2009

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

Authorized official

Name
Dr. Drew J Marentette, D.C.NPI 1417935107
Title
Owner
Phone
(989) 345-3310

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DM007681 MI Primary

Addresses

Primary practice location

110 E Houghton Ave
West Branch, MI 48661-1124

Mailing address

110 E Houghton Ave
West Branch, MI 48661-1124
Phone (989) 345-3310

Other identifiers 2

IdentifierTypeStateIssuer
950F510500OtherMIBLUE CROSS BLUE SHIELD OF MICHIGAN
950F55000OtherMIBLUE CROSS BLUE SHIELD MI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040622000828 MI Part B Supplier - Clinic/Group Practice 1456336668 Receives reassigned benefits from 1 practitioner
Practice locations: West Branch, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238457600000",
    "number": "1629273743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E HOUGHTON AVE",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "486611124",
            "telephone_number": "989-345-3310",
            "fax_number": "989-345-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E HOUGHTON AVE",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "486611124",
            "telephone_number": "989-345-3310",
            "fax_number": "989-345-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST BRANCH CHIROPRACTIC CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2009-03-31",
        "status": "A",
        "authorized_official_last_name": "MARENTETTE",
        "authorized_official_first_name": "DREW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-345-3310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "DM007681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "950F510500",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "950F55000",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Branch, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; 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.