NPIMap

Organization Active NPI

Great Lakes Chiropractic, P.C.

  • Orthopedic Chiropractor
  • Sterling Heights, MI
National Provider Identifier
1902045685
Registry record updated Feb 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
2301007508 Issued in MI
Legal business name
GREAT LAKES CHIROPRACTIC, P.C.
Practice address
4105 Metropolitan Pkwy
Suite 101
Sterling Heights, MI 48310-7503
Phone
(586) 939-1003
Fax
(586) 939-3862
NPI assigned
Feb 19, 2009
Last updated
Feb 19, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2009

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

Authorized official

Name
Dr. John G. Bloodworth, D.C.NPI 1104866730
Title
President
Phone
(586) 939-1003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NX0800X 2301007508 MI Primary

Addresses

Primary practice location

4105 Metropolitan Pkwy
Suite 101
Sterling Heights, MI 48310-7503

Mailing address

4105 Metropolitan Pkwy
Suite 101
Sterling Heights, MI 48310-7503
Phone (586) 939-1003

National Provider Directory

National Provider Directory

Locations

4105 Metropolitan Pkwy
Sterling Heights, MI 48310
Phone (586) 939-1003

4105 Metropolitan Pkwy
Ste 101
Sterling Hts, MI 48310
Phone (586) 939-1003

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1902045685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 METROPOLITAN PKWY",
            "address_2": "SUITE 101",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483107503",
            "telephone_number": "586-939-1003",
            "fax_number": "586-939-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 METROPOLITAN PKWY",
            "address_2": "SUITE 101",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483107503",
            "telephone_number": "586-939-1003",
            "fax_number": "586-939-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES CHIROPRACTIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "BLOODWORTH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-939-1003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "MI",
            "license": "2301007508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.