Justin Nicholas Fountain, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301009700 Issued in MI

Practice address

3396 I 75 Business Spur
Unit D
Sault Sainte Marie, MI 49783-3629

Phone

(906) 484-1034

Fax

(906) 484-1064

NPI assigned

Jan 26, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fountain of Life Chiropractic PC

  • Chiropractor
  • Petoskey, MI
  • NPI 1710323993
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546905600000",
    "number": "1659677417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3396 I 75 BUSINESS SPUR",
            "address_2": "UNIT D",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833629",
            "telephone_number": "906-484-1034",
            "fax_number": "906-484-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3396 I 75 BUSINESS SPUR",
            "address_2": "UNIT D",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833629",
            "telephone_number": "906-484-1034",
            "fax_number": "906-484-1064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "JUSTIN",
        "middle_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-26",
        "last_updated": "2019-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley C Fisher, PAC
• Crystal Fitzgerald
• Vivica J Fitzpatrick-Sherman, MD
• FMG Meridian Street Michigan LLC (Tendercare Sault Ste. Marie)
• Kathryn Hannah Forgit, DMD
• David Frank
• Zachary T Freeman
• Laura M Gagnon
• Hilary Clodagh Galey, PT
• Richard W Ganzhorn, M.D.

• Chiropractor in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; 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.