NPIMap

Organization Active NPI

Lietz Chiropractic and Applied Kinesiology LLC

  • Chiropractor
  • Grandville, MI
National Provider Identifier
1700124237
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
L2083320 Issued in MI
Legal business name
LIETZ CHIROPRACTIC AND APPLIED KINESIOLOGY LLC
Practice address
3550 Fairlanes Ave SW
Suite B
Grandville, MI 49418-1572
Phone
(616) 530-3333
Fax
(616) 608-3803
NPI assigned
Jan 17, 2013
Last updated
Jan 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Authorized official

Name
Dr. Charles Michael Lietz, D.C.NPI 1568682201
Title
Sole Member
Phone
(616) 530-3333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X L2083320 MI Primary

Addresses

Primary practice location

3550 Fairlanes Ave SW
Suite B
Grandville, MI 49418-1572

Mailing address

3550 Fairlanes Ave SW
Suite B
Grandville, MI 49418-1572
Phone (616) 530-3333

National Provider Directory

National Provider Directory

Locations

3550 Fairlanes Ave SW
Ste B
Grandville, MI 49418
Phone (616) 530-3333

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1700124237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 FAIRLANES AVE SW",
            "address_2": "SUITE B",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181572",
            "telephone_number": "616-530-3333",
            "fax_number": "616-608-3803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 FAIRLANES AVE SW",
            "address_2": "SUITE B",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181572",
            "telephone_number": "616-530-3333",
            "fax_number": "616-608-3803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIETZ CHIROPRACTIC AND APPLIED KINESIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-17",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "LIETZ",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "616-530-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "L2083320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; 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.