Organization Active NPI

Dynamic Essence Chiropractic Center, PLLC

  • Chiropractor
  • Grand Rapids, MI
National Provider Identifier
1679097109
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010564 Issued in MI
Legal business name
DYNAMIC ESSENCE CHIROPRACTIC CENTER, PLLC
Practice address
1324 Lake Dr SE Ste 1
Grand Rapids, MI 49506-1673
Phone
(616) 591-3925
NPI assigned
Jul 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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

Authorized official

Name
Lisa Fisher
Title
Owner/DC
Phone
(616) 591-3925

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2301010564 MI Primary

Addresses

Primary practice location

1324 Lake Dr SE Ste 1
Grand Rapids, MI 49506-1673

Mailing address

1324 Lake Dr SE Ste 1
Grand Rapids, MI 49506-1673
Phone (989) 573-1170

Other practice location 1

1324 Lake Dr SE Ste 1
Grand Rapids, MI 49506-1673
Phone (616) 591-3925

National Provider Directory

National Provider Directory

Locations

1324 Lake Dr SE
Ste 1
Grand Rapids, MI 49506
Phone (616) 591-3925

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": "1501027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565308800000",
    "number": "1679097109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 LAKE DR SE STE 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061673",
            "telephone_number": "989-573-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 LAKE DR SE STE 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061673",
            "telephone_number": "616-591-3925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1324 Lake Dr SE Ste 1",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495061673",
            "country_code": "US",
            "telephone_number": "616-591-3925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DYNAMIC ESSENCE CHIROPRACTIC CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-26",
        "last_updated": "2019-08-09",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER/DC",
        "authorized_official_telephone_number": "616-591-3925"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.