Individual provider Active NPI

Michelle Rebecca Severson, D.C.

  • Chiropractor
  • Rocky Mount, VA
National Provider Identifier
1780916122
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104556868 Issued in VA
Practice address
920 Tanyard Rd
Suite 102
Rocky Mount, VA 24151-1543
Phone
(540) 483-3678
Fax
(540) 483-3820
NPI assigned
Feb 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104556868 VA Primary
Chiropractor 111N00000X DC010498 PA

Addresses

Primary practice location

920 Tanyard Rd
Suite 102
Rocky Mount, VA 24151-1543

Mailing address

920 Tanyard Rd
Suite G
Rocky Mount, VA 24151-1543
Phone (540) 483-4344

Other identifiers 1

IdentifierTypeStateIssuer
C05545OtherVAMEDICARE GROUP PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120519000080 VA Practitioner - Chiropractic 4587827043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

920 Tanyard Rd
Rocky Mount, VA 24151-1543
Phone (540) 483-4344

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC010498PAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Touch Chiropractic & Wellness Inc Chiropractor CurrentSince Mar 1, 2017 Accepting new patients
Tuck Chiropractic Corporation PastSince Dec 15, 2024 Accepting new patients
Tuck Chiropractic Corporation Chiropractor PastSince Sep 1, 2024 Accepting new patients

Locations

920 Tanyard Rd
Ste 102
Rocky Mount, VA 24151
Phone (540) 483-3678

920 Tanyard Rd
Ste G
Rocky Mount, VA 24151

920 Tanyard Rd
Rocky Mount, VA 24151
Phone (540) 483-4344

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1265760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489449600000",
    "number": "1780916122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 TANYARD RD",
            "address_2": "SUITE G",
            "city": "ROCKY MOUNT",
            "state": "VA",
            "postal_code": "241511543",
            "telephone_number": "540-483-4344",
            "fax_number": "844-726-9867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 TANYARD RD",
            "address_2": "SUITE 102",
            "city": "ROCKY MOUNT",
            "state": "VA",
            "postal_code": "241511543",
            "telephone_number": "540-483-3678",
            "fax_number": "540-483-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVERSON",
        "first_name": "MICHELLE",
        "middle_name": "REBECCA",
        "name_prefix": "Ms.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-10",
        "last_updated": "2017-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556868",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC010498",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "C05545",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; 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.

Verify at the official NPI Registry.