Active NPI
Michael R Petchauer, D.C.
- Chiropractor
- Holland, MI
National Provider Identifier
1639193444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4873
- Practice address
- 671 Douglas Ave
Holland, MI 49424-2783 - Phone
- (616) 394-0112
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4873 | MI | Primary |
Addresses
Primary practice location
671 Douglas Ave
Holland, MI 49424-2783
Mailing address
671 Douglas Ave
Holland, MI 49424-2783
Phone (616) 394-0112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071214000569 | MI | Practitioner - Chiropractic | 9133219090 | Practice locations: Holland, MI |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4873 | MI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326067200000",
"number": "1639193444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "671 DOUGLAS AVE",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494242783",
"telephone_number": "616-394-0112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "671 DOUGLAS AVE",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494242783",
"telephone_number": "616-394-0112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETCHAUER",
"first_name": "MICHAEL",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2012-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MI",
"license": "4873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; 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.