Great Lakes Family Chiropractic, Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301008451 Issued in MI

Legal business name

GREAT LAKES FAMILY CHIROPRACTIC, INC.

Practice address

3138 Broadmoor Ave SE
Kentwood, MI 49512-1845

Phone

(616) 241-4040

Fax

(616) 475-6953

NPI assigned

Jan 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Douglas Gene McKenzie, D.C.NPI 1902928724

Title

Dr. Owner

Phone

(616) 241-4040

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

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

• Douglas Gene McKenzie, D.C.

  • Chiropractor
  • Kentwood, MI
  • NPI 1902928724
  Medicare reassignment NPD Authorized official
• Holly Elizebeth York, D.C.

  • Chiropractor
  • Kentwood, MI
  • NPI 1376728568
  NPD (past)

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811975717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3138 BROADMOOR AVE SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495121845",
            "telephone_number": "616-241-4040",
            "fax_number": "616-475-6953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3138 BROADMOOR AVE SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495121845",
            "telephone_number": "616-241-4040",
            "fax_number": "616-475-6953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES FAMILY CHIROPRACTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCKENZIE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "DR. OWNER",
        "authorized_official_telephone_number": "616-241-4040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4754106",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.