Healthsource Chiropractic and Progressive Rehab of Pella Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

007228 Issued in IA

Legal business name

HEALTHSOURCE CHIROPRACTIC AND PROGRESSIVE REHAB OF PELLA INC

Practice address

2720 E 40TH CT
Des Moines, IA 50317-5540

Phone

(641) 780-3375

NPI assigned

Jul 6, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Ross Aaron Groenendyk, D.C.NPI 1780917435

Title

Owner

Phone

(641) 780-3375

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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.

• Ross Aaron Groenendyk, D.C.

  • Chiropractor
  • Pella, IA
  • NPI 1780917435
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1811284235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 WASHINGTON ST",
            "address_2": "SUITE 2",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191556",
            "telephone_number": "641-780-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 E 40TH CT",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503175540",
            "telephone_number": "641-780-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE CHIROPRACTIC AND PROGRESSIVE REHAB OF PELLA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-06",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "GROENENDYK",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "641-780-3375",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "007228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.