Individual provider Active NPI

Jean Laine

  • Rehabilitation Chiropractor
  • Brooklyn, NY
National Provider Identifier
1972792760
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
X011370-1 Issued in NY
Practice address
649 E 81St St
Brooklyn, NY 11236-3303
Phone
(917) 295-5048
NPI assigned
Oct 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X X011370-1 NY Primary

Addresses

Primary practice location

649 E 81St St
Brooklyn, NY 11236-3303

Mailing address

649 E 81St St
Brooklyn, NY 11236-3303
Phone (917) 295-5048

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)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
X011370-1NYMDRehabilitation Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic 4 Life CurrentSince Oct 13, 2024 Accepting new patients
Kirkwood Pain & Injury Chiropracitc Center Current Accepting new patients

Locations

17526 W 7 Mile Rd
Detroit, MI 48235
Phone (313) 889-1625

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1972792760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "649 E 81ST ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363303",
            "telephone_number": "917-295-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "649 E 81ST ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363303",
            "telephone_number": "917-295-5048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAINE",
        "first_name": "JEAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NY",
            "license": "X011370-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.