Jay Andrew Stark, DC
Individual provider Active NPI Chiropractor · Ortonville, MI
NPI 1962578575 · NPPES record last updated Nov 18, 2007
Key facts
- NPI
- 1962578575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- JS007228 (MI)
- Practice address
- 70 Ortonville Rd
Brandon Chiropractic Center
Ortonville, MI 48462 - Phone
- (248) 627-9595
- Fax
- (248) 627-9379
- NPI assigned
- Nov 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
125 N Ortonville Rd a
Ortonville, MI 48462-8531
Phone (248) 627-9595
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041008001480 | MI | Practitioner - Chiropractic | 3870486988 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JS007228 | MI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caro Chiropractic PC | Chiropractor | Current |
Accepting new patients |
| Otisville Chiropractic Center PC | Chiropractor | Past |
Accepting new patients |
Locations
125 N Ortonville Rd
#A
Ortonville, MI 48462
Phone (248) 627-9595
125 N Ortonville Rd
Ortonville, MI 48462
Phone (248) 627-9595
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | JS007228 | MI | Yes |
Addresses
Primary practice location
70 Ortonville Rd
Brandon Chiropractic Center
Ortonville, MI 48462
Mailing address
70 Ortonville Rd
Brandon Chiropractic Center
Ortonville, MI 48462
Phone (248) 627-9595
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P107713 | Other | BCN HMO |
Other providers in Ortonville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.