Michigan Spine Center LLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

2301009010 Issued in MI

Legal business name

MICHIGAN SPINE CENTER LLC

Practice address

30325 Gratiot Ave
Roseville, MI 48066-1714

Phone

(586) 774-6301

NPI assigned

Dec 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jason A Stanczak, D,C,NPI 1760511877

Title

Owner

Phone

(586) 774-6301

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.

• Jason Aaron Stanczak, D.C.

  • Rehabilitation Chiropractor
  • Roseville, MI
  • NPI 1760511877
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1871777235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30325 GRATIOT AVE",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480661714",
            "telephone_number": "586-774-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30325 GRATIOT AVE",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480661714",
            "telephone_number": "586-774-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN SPINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "STANCZAK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-774-6301",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D,C,"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "MI",
            "license": "2301009010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Chiropractor in Roseville, MI
• Providers in Roseville, MI by specialty
• Rehabilitation Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; 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.