Active NPI
Bryan Born, DC
- Chiropractor
- Southfield, MI
National Provider Identifier
1750378659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2301005852
- Practice address
- 15831 W 12 Mile Rd
Southfield, MI 48076-3011 - Phone
- (248) 559-6763
- NPI assigned
- Oct 5, 2005
- Last updated
- Sep 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2301005852 | MI | Primary |
Addresses
Primary practice location
15831 W 12 Mile Rd
Southfield, MI 48076-3011
Mailing address
15831 W 12 Mile Rd
Southfield, MI 48076-3011
Phone (248) 559-6763
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 950F353420 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040218000198 | MI | Practitioner - Chiropractic | 2668367764 | Practice locations: Southfield, MI |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
15831 W 12 Mile Rd
Southfield, MI 48076-3011
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2301005852 | MI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347840000000",
"number": "1750378659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15831 W 12 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480763011",
"telephone_number": "248-559-6763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15831 W 12 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480763011",
"telephone_number": "248-559-6763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORN",
"first_name": "BRYAN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-05",
"last_updated": "2012-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MI",
"license": "2301005852",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "950F353420",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; 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.