Fountain of Life Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

FOUNTAIN OF LIFE CHIROPRACTIC PC

Practice address

267 Creekside Dr
Suite 100
Petoskey, MI 49770-7609

Phone

(231) 347-1776

Fax

(231) 347-1778

NPI assigned

May 15, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Justin Nicholas Fountain, D.C.NPI 1659677417

Title

President/Owner

Phone

(906) 440-9272

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Justin Nicholas Fountain, D.C.

  • Chiropractor
  • Sault Sainte Marie, MI
  • NPI 1659677417
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1710323993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 CREEKSIDE DR",
            "address_2": "SUITE 100",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497707609",
            "telephone_number": "231-347-1776",
            "fax_number": "231-347-1778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 CREEKSIDE DR",
            "address_2": "SUITE 100",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497707609",
            "telephone_number": "231-347-1776",
            "fax_number": "231-347-1778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF LIFE CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "FOUNTAIN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "906-440-9272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noel Louise Fleming, TLLP
• Bridget Swartz Foltz, MPT
• Matthew Robert Font, D.O.
• Mary Ford
• Lisa Marie Fortin, M.D.
• Four Seasons Natural Health
• Olivia Marie Francis, OTR/L
• Ginger Leigh Fricke, LMSW
• Friendship Centers of Emmet County
• Sharon Zamjohn Frost, O.T.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.