Active NPI
Demetra Mydlo, DC
- Chiropractor
- Zeeland, MI
National Provider Identifier
1962931709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2301010567
- Practice address
- 10990 Chicago Dr
Zeeland, MI 49464-8100 - Phone
- (616) 546-3500
- NPI assigned
- Jun 6, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2301010567 | MI | Primary |
Addresses
Primary practice location
10990 Chicago Dr
Zeeland, MI 49464-8100
Mailing address
13745 Carmella LN Apt F
Holland, MI 49424-8483
Phone (586) 484-9666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2301010567 | MI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496707200000",
"number": "1962931709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13745 CARMELLA LN APT F",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494248483",
"telephone_number": "586-484-9666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10990 CHICAGO DR",
"city": "ZEELAND",
"state": "MI",
"postal_code": "494648100",
"telephone_number": "616-546-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYDLO",
"first_name": "DEMETRA",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-06",
"last_updated": "2017-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MI",
"license": "2301010567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Zeeland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.