Prospine and Sports P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301009748 Issued in MI

Legal business name

PROSPINE AND SPORTS P.C.

Practice address

32738 Grand River Ave
Farmington, MI 48336-3132

Phone

(248) 615-1381

NPI assigned

Jun 4, 2013

Last updated

Jun 4, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dustin Mattila, D.C.NPI 1578891693

Title

President

Phone

(248) 615-1381

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 2

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.

• Dustin Philip Mattila, D.C.

  • Chiropractor
  • Howell, MI
  • NPI 1578891693
  Medicare reassignment NPD Authorized official
• Laith Arabi

  • Chiropractor
  • Commerce Township, MI
  • NPI 1699522201
  Medicare reassignment NPD

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370304000000",
    "number": "1700223435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32738 GRAND RIVER AVE",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483363132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32738 GRAND RIVER AVE",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483363132",
            "telephone_number": "248-615-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPINE AND SPORTS P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-04",
        "last_updated": "2013-06-04",
        "status": "A",
        "authorized_official_last_name": "MATTILA",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-615-1381",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Renee Peters
• Pharmasource LTC LLC
• Prodigal Journey, LLC
• Professional Dental Alliance of Farmington, PLLC (Stoneybrook Dental)
• Professional Services of Sherry Mullins, LLC (Heyoka Counseling Service)
• Elizabeth Ann Putt
• Quantum Diagnostic LLC
• Marilyn J Radojcich, OTR
• Rainbow Rehabilitation Centers, Inc.
• Kara Rambo, CPNP

• Chiropractor in Farmington, MI
• Providers in Farmington, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.