Williamston Sport and Spine Chiropractic Clinic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301009865 Issued in MI

Legal business name

WILLIAMSTON SPORT AND SPINE CHIROPRACTIC CLINIC

Practice address

425 W Grand River Ave
Suite D
Williamston, MI 48895-1343

Phone

(517) 655-2468

Fax

(517) 655-5678

NPI assigned

Mar 28, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Robert Zimmerman, D.C.NPI 1144594110

Title

Chiropractor/Owner

Phone

(989) 721-6878

Specialties & licenses 1

Addresses

Other names 1

• Williamston Sport and Spine Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

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

• Kyle Robert Zimmerman, D.C.

  • Chiropractor
  • Owosso, MI
  • NPI 1144594110
  Medicare reassignment NPD Authorized official
• Keith Randall Denning, D.C.

  • Chiropractor
  • Grand Blanc, MI
  • NPI 1922137165
  NPD (past)
• Krystal Renee Siminski, DC

  • Chiropractor
  • Owosso, MI
  • NPI 1023395472
  NPD (past)

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

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369008000000",
    "number": "1659614501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W GRAND RIVER AVE",
            "address_2": "SUITE D",
            "city": "WILLIAMSTON",
            "state": "MI",
            "postal_code": "488951343",
            "telephone_number": "517-655-2468",
            "fax_number": "517-655-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W GRAND RIVER AVE",
            "address_2": "SUITE D",
            "city": "WILLIAMSTON",
            "state": "MI",
            "postal_code": "488951343",
            "telephone_number": "517-655-2468",
            "fax_number": "517-655-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSTON SPORT AND SPINE CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-28",
        "last_updated": "2013-05-20",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "989-721-6878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamston Sport and Spine Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shelly Renee Vliet, NURSE PRACTITIONER
• Robert Raymond Watts, DDS
• Carol Z Way, LMSW
• William T Mangan Jr, DO PLLC
• Williamston Compassionate Care
• Williamston Wellness PLLC
• Young Mind Therapy, LLC

• All providers in Williamston, MI
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; 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.