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Parkhurst Chiropractic Life Center PLC 364 Garden Ave. Holland, MI 49424-8656 616-392-9500 office@parkhurstchiropractic.com Insurance Accounts Receivable Report All Dates Visit Date Charge Disputed First Billed Last Billed Aged 0 to 30 Aged 31 to 60 Aged 61 to 90 Aged 91 to 120 Aged 121+ Total Owed AARP Healthcare 800-523-5800 BOWBA000 Bowen, Barbara Group: DOB: 06/20/1949 Insured ID: 032773928-12 09/27/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/26/22 0.00 7.76 0.00 0.00 0.00 7.76 Provider: Dr Russell Sweet DC Patient Totals: 0.00 7.76 0.00 0.00 0.00 7.76 DROMA000 Drost, Marla Group: PLAN F DOB: 06/13/1947 Insured ID: 038536341-12 09/15/21 98942-AT - Manipulation 5 Regions No 09/21/21 10/21/22 0.00 0.00 0.00 0.00 10.27 10.27 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 10.27 10.27 LACRO000 Lacy, Rosemary Group: DOB: 01/17/1955 Insured ID: 343996195-12 07/25/22 98941-AT - Manipulation 3-4 Regions No 08/01/22 10/13/22 0.00 0.00 0.00 38.78 0.00 38.78 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.00 0.00 38.78 0.00 38.78 LANDE000 Lankheet, Dennis Group: DOB: 05/30/1938 Insured ID: 047560181-11 09/21/22 98941-AT - Manipulation 3-4 Regions No 09/26/22 10/24/22 0.00 7.76 0.00 0.00 0.00 7.76 Provider: Dr James Friess DC Patient Totals: 0.00 7.76 0.00 0.00 0.00 7.76 Carrier Totals: 0.00 15.52 0.00 38.78 10.27 64.57 AETNA 888-632-3862 AGAJE001 Agar, Jennifer Group: 469618-12-001 DOB: 07/03/1975 Insured ID: W211497084 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 29.14 0.00 0.00 0.00 0.00 29.14 Provider: Dr James Friess DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 29.14 0.00 0.00 0.00 0.00 29.14 Provider: Dr James Friess DC 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr James Friess DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr James Friess DC 10/25/22 97140-GP-59-97 - No 10/31/22 10/31/22 46.26 0.00 0.00 0.00 0.00 46.26 Page 1 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Therapy-Manual (Trigger Point, Myofascial Release) Provider: Dr James Friess DC Patient Totals: 130.12 0.00 0.00 0.00 0.00 130.12 AGAJO001 Agar, Joshua Group: 46961812001 DOB: 07/23/2004 Insured ID: W211497084 10/18/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/24/22 10/24/22 46.26 0.00 0.00 0.00 0.00 46.26 Provider: Dr James Friess DC 09/23/22 98942-AT - Manipulation 5 Regions No 09/29/22 09/29/22 0.00 37.46 0.00 0.00 0.00 37.46 Provider: Dr James Friess DC Patient Totals: 46.26 37.46 0.00 0.00 0.00 83.72 BAREM000 Barry, Emily, R Group: 028390001400007 DOB: 03/01/2000 Insured ID: W223870061 09/19/22 72070 - X-ray Thoracic Spine - 2-3 Views No 09/29/22 09/29/22 0.00 56.50 0.00 0.00 0.00 56.50 Provider: Dr Russell Sweet DC 09/19/22 72100 - X-ray Lumbosacral 2-3 Views No 09/29/22 09/29/22 0.00 68.50 0.00 0.00 0.00 68.50 Provider: Dr Russell Sweet DC 09/19/22 72040 - X-ray Cervical Spine - 2-3 Views No 09/29/22 09/29/22 0.00 68.00 0.00 0.00 0.00 68.00 Provider: Dr Russell Sweet DC 10/04/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/05/22 10/05/22 0.00 14.06 0.00 0.00 0.00 14.06 Provider: Dr Russell Sweet DC Patient Totals: 0.00 207.06 0.00 0.00 0.00 207.06 BLOJO001 Bloemers, Jonathan Group: 477158-012-00006 DOB: 09/06/2005 Insured ID: W251105281 09/27/22 99202-25 - New Patient Exam - 15- 29 Min No 10/03/22 10/03/22 0.00 49.08 0.00 0.00 0.00 49.08 Provider: Dr Jeremy Lengkeek DC Patient Totals: 0.00 49.08 0.00 0.00 0.00 49.08 CRUAL000 Cruz, Alicia Group: 144124-020-00011 DOB: 07/23/1997 Insured ID: W265118909 10/13/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 29.14 0.00 0.00 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC 10/13/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/20/22 10/20/22 49.06 0.00 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC Patient Totals: 78.20 0.00 0.00 0.00 0.00 78.20 ECCRY000 Eccker, Ryan Group: 0326476-010-00143 DOB: 11/09/1995 Insured ID: W821333173 09/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/26/22 09/26/22 0.00 39.25 0.00 0.00 0.00 39.25 Provider: Dr Brian S Parkhurst DC Page 2 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
09/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/26/22 09/26/22 0.00 39.25 0.00 0.00 0.00 39.25 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 78.50 0.00 0.00 0.00 78.50 FILSU000 Filipovic, Suvada Group: 469618-11-001 DOB: 09/01/1973 Insured ID: W168503278 09/21/22 97012-GP - Therapy- Traction/Mechanical No 09/26/22 09/26/22 0.00 0.25 0.00 0.00 0.00 0.25 Provider: Dr Karla A Parkhurst DC 09/23/22 97012-GP - Therapy- Traction/Mechanical No 09/29/22 09/29/22 0.00 0.25 0.00 0.00 0.00 0.25 Provider: Dr Karla A Parkhurst DC 09/30/22 97012-GP - Therapy- Traction/Mechanical No 10/05/22 10/05/22 0.00 0.25 0.00 0.00 0.00 0.25 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.75 0.00 0.00 0.00 0.75 HOFRO000 Hoffman, Robert Group: 608598-40-142 DOB: 12/18/1931 Insured ID: W013065253 07/18/22 98941-AT - Manipulation 3-4 Regions No 07/21/22 10/05/22 0.00 0.00 0.00 7.76 0.00 7.76 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 7.76 0.00 7.76 LAKJE000 Lake, Jennifer Group: 469618-10-001 DOB: 03/02/1983 Insured ID: W222460677 10/12/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/07/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/10/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/14/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/17/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 49.06 0.00 0.00 0.00 0.00 49.06 Provider: Dr Karla A Parkhurst DC 10/14/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC Page 3 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/12/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Russell Sweet DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/20/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Samantha J Spooner DC 10/10/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/07/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 0.00 37.46 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/07/22 99213-25 - Established Patient Exam - 20-29 Min No 10/31/22 10/31/22 0.00 58.27 0.00 0.00 0.00 58.27 Provider: Dr Karla A Parkhurst DC Patient Totals: 337.77 108.52 0.00 0.00 0.00 446.29 POLDE000 Pols, Debbie Group: 141987-10-001 DOB: 08/22/1964 Insured ID: W253365428 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 7.46 0.00 0.00 0.00 0.00 7.46 Provider: Dr James Friess DC 10/14/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 7.46 0.00 0.00 0.00 0.00 7.46 Provider: Dr James Friess DC Patient Totals: 14.92 0.00 0.00 0.00 0.00 14.92 RAMPA000 Ramos, Patty Group: 469618-12-001 DOB: 12/24/1965 Insured ID: W168503018 10/06/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 29.14 0.00 0.00 0.00 29.14 Provider: Dr James Friess DC Patient Totals: 0.00 29.14 0.00 0.00 0.00 29.14 ROMLU000 Romano, Luca Group: 285583-10-001 DOB: 08/31/2002 Insured ID: W254526006 08/17/22 97012-GP - Therapy- Traction/Mechanical No 08/22/22 10/05/22 0.00 0.00 12.79 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 09/01/22 97012-GP - Therapy- Traction/Mechanical No 09/07/22 09/07/22 0.00 0.00 12.79 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 09/14/22 97012-GP - Therapy- Traction/Mechanical No 09/19/22 09/19/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 08/05/22 97012-GP - Therapy- No 08/11/22 10/05/22 0.00 0.00 0.00 12.79 0.00 12.79 Page 4 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Traction/Mechanical Provider: Dr Brian S Parkhurst DC 09/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/03/22 10/03/22 0.00 49.06 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 10/05/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/10/22 10/10/22 0.00 49.06 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 09/15/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/22/22 09/22/22 0.00 49.06 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/29/22 10/05/22 0.00 0.00 49.06 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 09/01/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/07/22 09/07/22 0.00 0.00 49.06 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/15/22 10/05/22 0.00 0.00 0.00 49.06 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/17/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/22/22 10/05/22 0.00 0.00 49.06 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/05/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/11/22 10/05/22 0.00 0.00 0.00 49.06 0.00 49.06 Provider: Dr Brian S Parkhurst DC 06/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/28/22 10/05/22 0.00 0.00 0.00 0.00 49.06 49.06 Provider: Dr Brian S Parkhurst DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 08/05/22 98941-AT - Manipulation 3-4 Regions No 08/11/22 10/05/22 0.00 0.00 0.00 29.14 0.00 29.14 Provider: Dr Brian S Parkhurst DC 08/17/22 98941-AT - Manipulation 3-4 Regions No 08/22/22 10/05/22 0.00 0.00 29.14 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC 09/01/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/07/22 0.00 0.00 29.14 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC 09/14/22 98941-AT - Manipulation 3-4 No 09/19/22 09/19/22 0.00 29.14 0.00 0.00 0.00 29.14 Page 5 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Regions Provider: Dr Brian S Parkhurst DC 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 29.14 0.00 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 231.04 231.04 140.05 49.06 651.19 TAUGE000 Taubert, Gerald, T Group: 100008-02EG0009 DOB: 03/30/1949 Insured ID: 101235782100 06/06/22 98942-AT - Manipulation 5 Regions No 06/09/22 09/19/22 0.00 0.00 0.00 0.00 17.46 17.46 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 17.46 17.46 VANBR004 VanKley, Brian Group: 039363002700002 DOB: 12/13/1973 Insured ID: W273547226 05/25/22 98941-AT - Manipulation 3-4 Regions No 06/02/22 10/31/22 0.00 0.00 0.00 0.00 50.00 50.00 Provider: Dr Russell Sweet DC Patient Totals: 0.00 0.00 0.00 0.00 50.00 50.00 Carrier Totals: 607.27 741.55 231.04 147.81 116.52 1,844.19 AETNA 800-345-4061 MANTO000 Mannes, Tonya Group: 144124-020-00011 DOB: 02/25/1975 Insured ID: W257370741 09/21/22 97012-GP - Therapy- Traction/Mechanical No 09/26/22 09/26/22 0.00 11.93 0.00 0.00 0.00 11.93 Provider: Dr James Friess DC 10/10/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/13/22 10/13/22 8.42 0.00 0.00 0.00 0.00 8.42 Provider: Dr James Friess DC 10/03/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/10/22 10/10/22 0.00 8.42 0.00 0.00 0.00 8.42 Provider: Dr James Friess DC 10/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/13/22 10/13/22 24.53 0.00 0.00 0.00 0.00 24.53 Provider: Dr James Friess DC 10/03/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/10/22 10/10/22 0.00 24.53 0.00 0.00 0.00 24.53 Provider: Dr James Friess DC 10/03/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/10/22 10/10/22 0.00 16.26 0.00 0.00 0.00 16.26 Provider: Dr James Friess DC 10/10/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/13/22 10/13/22 16.26 0.00 0.00 0.00 0.00 16.26 Provider: Dr James Friess DC Patient Totals: 49.21 61.14 0.00 0.00 0.00 110.35 WEBLO000 Weber, Lori Group: 086867102500002 DOB: 06/01/1962 Insured ID: W263964144 10/04/22 72040 - X-ray Cervical Spine - 2-3 No 10/24/22 10/24/22 0.00 71.00 0.00 0.00 0.00 71.00 Page 6 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Views Provider: Dr Russell Sweet DC 10/04/22 99203-25 - New Patient Exam - 30- 44 Min No 10/17/22 10/17/22 0.00 37.77 0.00 0.00 0.00 37.77 Provider: Dr Russell Sweet DC 10/04/22 72070 - X-ray Thoracic Spine - 2-3 Views No 10/24/22 10/24/22 0.00 59.00 0.00 0.00 0.00 59.00 Provider: Dr Russell Sweet DC 10/04/22 72100 - X-ray Lumbosacral 2-3 Views No 10/24/22 10/24/22 0.00 72.00 0.00 0.00 0.00 72.00 Provider: Dr Russell Sweet DC Patient Totals: 0.00 239.77 0.00 0.00 0.00 239.77 Carrier Totals: 49.21 300.91 0.00 0.00 0.00 350.12 AETNA Medicare / Managed Care HOLAR000 Holden, Ardice Group: DOB: 02/12/1950 Insured ID: MEBVNV8T 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 17.46 0.00 0.00 0.00 0.00 17.46 Provider: Dr James Friess DC 10/06/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 9.14 0.00 0.00 0.00 9.14 Provider: Dr James Friess DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 9.14 0.00 0.00 0.00 0.00 9.14 Provider: Dr James Friess DC Patient Totals: 26.60 9.14 0.00 0.00 0.00 35.74 MALJU000 Malone, Julia Group: DOB: 03/25/1965 Insured ID: 101549187600 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 09/01/22 98942-AT - Manipulation 5 Regions No 09/07/22 09/07/22 0.00 0.00 37.46 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC Patient Totals: 37.46 0.00 37.46 0.00 0.00 74.92 MOOGE000 Moorman, George Group: 354647 DOB: 08/25/1955 Insured ID: MEBT44ZD 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 9.14 0.00 0.00 0.00 0.00 9.14 Provider: Dr Brian S Parkhurst DC Patient Totals: 9.14 0.00 0.00 0.00 0.00 9.14 RETMI000 Rettler, Mia Group: 467248 DOB: 05/03/1998 Insured ID: MEBT9VVT 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC Patient Totals: 37.46 0.00 0.00 0.00 0.00 37.46 TEUAD000 Teunissen, Adrian Group: DOB: 06/30/1950 Insured ID: MEBS8JRP 10/26/22 98942-AT - Manipulation 5 No 10/31/22 10/31/22 17.46 0.00 0.00 0.00 0.00 17.46 Page 7 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Regions Provider: Dr Brian S Parkhurst DC Patient Totals: 17.46 0.00 0.00 0.00 0.00 17.46 TEUBA000 Teunissen, Barbara Group: DOB: 06/02/1949 Insured ID: MEBS724P 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 17.46 0.00 0.00 0.00 0.00 17.46 Provider: Dr Brian S Parkhurst DC Patient Totals: 17.46 0.00 0.00 0.00 0.00 17.46 Carrier Totals: 145.58 9.14 37.46 0.00 0.00 192.18 AETNA PPO 800-231-7729 HILAB000 Hilleshiem, Abigail Group: 479260-013-00001 DOB: 07/12/1986 Insured ID: W206850727 03/08/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/14/22 10/21/22 0.00 0.00 0.00 0.00 21.71 21.71 Provider: Dr Russell Sweet DC 03/08/22 97124-59-GP - Therapeutic Massage w/AIS No 03/14/22 10/21/22 0.00 0.00 0.00 0.00 35.46 35.46 Provider: Dr Russell Sweet DC Patient Totals: 0.00 0.00 0.00 0.00 57.17 57.17 Carrier Totals: 0.00 0.00 0.00 0.00 57.17 57.17 AETNA PPO 888-632-3862 JOHNI000 Johns, Nicole Group: 144124-021-00011 DOB: 11/07/1980 Insured ID: W259496241 10/12/22 97012-GP - Therapy- Traction/Mechanical No 10/17/22 10/17/22 11.93 0.00 0.00 0.00 0.00 11.93 Provider: Dr Russell Sweet DC 09/21/22 97012-GP - Therapy- Traction/Mechanical No 09/26/22 09/26/22 0.00 11.93 0.00 0.00 0.00 11.93 Provider: Dr Russell Sweet DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 11.93 0.00 0.00 0.00 11.93 Provider: Dr Russell Sweet DC Patient Totals: 11.93 23.86 0.00 0.00 0.00 35.79 Carrier Totals: 11.93 23.86 0.00 0.00 0.00 35.79 AETNA US Healthcare 877-204-9064 ARRCA000 Arreola, Carrie Group: DOB: 09/22/1975 Insured ID: W263957898 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 29.14 0.00 0.00 0.00 29.14 Provider: Dr Karla A Parkhurst DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 41.93 0.00 0.00 0.00 41.93 GARAN000 Garza, Anita Group: 283912-040-00100 DOB: 03/19/1971 Insured ID: W235597891 10/13/22 97012-GP - Therapy- Traction/Mechanical No 10/20/22 10/20/22 1.93 0.00 0.00 0.00 0.00 1.93 Provider: Dr James Friess DC Page 8 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
09/22/22 97012-GP - Therapy- Traction/Mechanical No 09/29/22 09/29/22 0.00 1.93 0.00 0.00 0.00 1.93 Provider: Dr James Friess DC Patient Totals: 1.93 1.93 0.00 0.00 0.00 3.86 LEMAV000 Lemire, Ava Group: 469618-12-001 DOB: 06/13/2008 Insured ID: W168501695 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/07/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 23.31 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 39.25 0.00 0.00 0.00 0.00 39.25 Provider: Dr Brian S Parkhurst DC Patient Totals: 109.18 23.31 0.00 0.00 0.00 132.49 LEMEL000 Lemire, Ellery Group: 469618-12-001 DOB: 06/29/2014 Insured ID: W168501695 09/22/22 98941-AT - Manipulation 3-4 Regions No 09/29/22 09/29/22 0.00 23.31 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 23.31 0.00 0.00 0.00 23.31 LEMRY000 Lemire, Ryan Group: 469618-12-001 DOB: 01/05/1977 Insured ID: W168501695 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 09/23/22 98941-AT - Manipulation 3-4 Regions No 09/29/22 09/29/22 0.00 23.31 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC Patient Totals: 69.93 23.31 0.00 0.00 0.00 93.24 Carrier Totals: 181.04 113.79 0.00 0.00 0.00 294.83 AMERISURE INSURANCE 800-257-1900 CAVJE000 Cavanagh, Jeff Group: DOB: 02/03/1964 Insured ID: 588141 04/13/22 97012-GP - Therapy- Traction/Mechanical No 04/14/22 10/21/22 0.00 0.00 0.00 0.00 24.00 24.00 Page 9 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr James Friess DC 04/13/22 98942-AT - Manipulation 5 Regions No 04/14/22 10/21/22 0.00 0.00 0.00 0.00 60.00 60.00 Provider: Dr James Friess DC 05/09/22 98942-AT - Manipulation 5 Regions No 05/12/22 10/21/22 0.00 0.00 0.00 0.00 60.00 60.00 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 0.00 144.00 144.00 Carrier Totals: 0.00 0.00 0.00 0.00 144.00 144.00 ASR Corporation 616-957-1751 MULAN000 Mulder, Anna Group: 1153 DOB: 10/13/1963 Insured ID: P0424938 11/23/21 98940-AT - Manipulation 1-2 Regions No 11/30/21 10/20/22 0.00 0.00 0.00 0.00 5.44 5.44 Provider: Dr Jeremy Lengkeek DC 12/14/21 98940-AT - Manipulation 1-2 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 5.44 5.44 Provider: Dr Jeremy Lengkeek DC Patient Totals: 0.00 0.00 0.00 0.00 10.88 10.88 Carrier Totals: 0.00 0.00 0.00 0.00 10.88 10.88 Auto Owners - Care Works 877-876-5621 HANLI000 Hanges, Lindsey Group: DOB: 05/02/1982 Insured ID: 0660005145-2010 10/25/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/21/22 10/21/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/17/22 10/17/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC 09/06/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/07/22 0.00 0.00 50.00 0.00 0.00 50.00 Provider: Dr Jeremy Lengkeek DC 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC Patient Totals: 150.08 0.00 50.00 0.00 0.00 200.08 HANTR000 Hanges, Travis Group: DOB: 04/24/1980 Insured ID: 066-0005145-2010 07/21/22 98941-AT - Manipulation 3-4 Regions No 07/28/22 10/21/22 0.00 0.00 0.00 50.00 0.00 50.00 Provider: Dr Jeremy Lengkeek DC 07/14/22 98941-AT - Manipulation 3-4 Regions No 07/21/22 10/21/22 0.00 0.00 0.00 50.00 0.00 50.00 Provider: Dr Jeremy Lengkeek DC 07/28/22 98941-AT - Manipulation 3-4 Regions No 08/04/22 11/07/22 0.00 0.00 0.00 36.72 0.00 36.72 Provider: Dr Jeremy Lengkeek DC Page 10 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Patient Totals: 0.00 0.00 0.00 136.72 0.00 136.72 Carrier Totals: 150.08 0.00 50.00 136.72 0.00 336.80 BCBS Federal 800-482-3600 CHAMO000 Chartrand, Monica Group: 106 DOB: 01/21/1967 Insured ID: R59177250 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Brian S Parkhurst DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 61.00 0.00 0.00 0.00 0.00 61.00 Provider: Dr Brian S Parkhurst DC Patient Totals: 105.52 0.00 0.00 0.00 0.00 105.52 JEFJE000 Jefferson, Jeannie Group: DOB: 12/02/1979 Insured ID: R61200807 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 39.52 0.00 0.00 0.00 0.00 39.52 Provider: Dr Jeremy Lengkeek DC Patient Totals: 39.52 0.00 0.00 0.00 0.00 39.52 JEFMA000 Jefferson, Matthew, C Group: DOB: 01/19/1979 Insured ID: R61200807 10/25/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Jeremy Lengkeek DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 32.72 0.00 0.00 0.00 0.00 32.72 MCMSU000 McMahon, Susan Group: DOB: 10/26/1969 Insured ID: R60023002 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Russell Sweet DC Patient Totals: 16.36 0.00 0.00 0.00 0.00 16.36 MUSLI000 Musgrove, Linda Group: 112 DOB: 02/16/1952 Insured ID: R58717078 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Jeremy Lengkeek DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 4.76 0.00 0.00 0.00 0.00 4.76 Provider: Dr Jeremy Lengkeek DC 10/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 63.94 0.00 0.00 0.00 0.00 63.94 Provider: Dr Jeremy Lengkeek DC Patient Totals: 85.06 0.00 0.00 0.00 0.00 85.06 WOORO000 Woodburn, Ronald, K Group: 106 DOB: 07/16/1953 Insured ID: R22452158 10/25/21 97110-GP-97 - Therapy- No 03/28/22 10/20/22 0.00 0.00 0.00 0.00 68.00 68.00 Page 11 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Therapeutic Exercise Provider: Dr Brian S Parkhurst DC 01/17/22 97110-GP-97 - Therapy- Therapeutic Exercise No 01/20/22 10/20/22 0.00 0.00 0.00 0.00 68.00 68.00 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 136.00 136.00 Carrier Totals: 279.18 0.00 0.00 0.00 136.00 415.18 Blue Care Network 800-255-1690 BALSA000 Bale, Sandra Group: 00285843 DOB: 05/09/1969 Insured ID: XYHM05471999 08/03/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/08/22 09/07/22 0.00 0.00 0.00 4.43 0.00 4.43 Provider: Dr Jeremy Lengkeek DC 08/03/22 97032-GP-59-97 - Therapy - E-Stim Attended No 08/08/22 09/07/22 0.00 0.00 0.00 18.00 0.00 18.00 Provider: Dr Jeremy Lengkeek DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Jeremy Lengkeek DC Patient Totals: 17.14 0.00 0.00 22.43 0.00 39.57 BARAD000 Barksdale, Adam Group: 00185486 DOB: 03/05/1977 Insured ID: XYH894807836 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 BIRTR000 Birce, Travis Group: 00276603 DOB: 07/17/1989 Insured ID: XYH916132241 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Jeremy Lengkeek DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Jeremy Lengkeek DC Patient Totals: 34.28 0.00 0.00 0.00 0.00 34.28 BUSJE000 Bush, Jean Group: 00285687 DOB: 06/28/1963 Insured ID: XYH891876401 10/19/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Karla A Parkhurst DC 06/22/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/28/22 10/05/22 0.00 0.00 0.00 0.00 69.30 69.30 Provider: Dr Karla A Parkhurst DC Patient Totals: 17.14 0.00 0.00 0.00 69.30 86.44 CALAL000 Calderon, Alexa Group: 00282466 DOB: 06/14/2004 Insured ID: XYH910419571 10/27/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 22.99 0.00 0.00 0.00 0.00 22.99 Page 12 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr Karla A Parkhurst DC Patient Totals: 22.99 0.00 0.00 0.00 0.00 22.99 KURSA000 Cockrum, Sandra Group: 00172582 DOB: 07/26/1964 Insured ID: XYH890626054 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 34.28 0.00 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 09/16/22 98941-AT - Manipulation 3-4 Regions No 09/22/22 09/22/22 0.00 34.28 0.00 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 08/31/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/07/22 0.00 0.00 34.28 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 34.28 0.00 0.00 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 10/12/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/17/22 10/17/22 23.10 0.00 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 09/29/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/05/22 10/05/22 0.00 23.10 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 09/16/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/22/22 09/22/22 0.00 23.10 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 08/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/07/22 09/07/22 0.00 0.00 23.10 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 23.10 0.00 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 09/29/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/05/22 10/05/22 0.00 18.00 0.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 10/12/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/17/22 10/17/22 18.00 0.00 0.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 10/28/22 97032-GP-59-97 - Therapy - E-Stim Attended No 11/03/22 11/03/22 18.00 0.00 0.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 08/31/22 97032-GP-59-97 - Therapy - E-Stim Attended No 09/07/22 09/07/22 0.00 0.00 18.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 09/16/22 97032-GP-59-97 - Therapy - E-Stim Attended No 09/22/22 09/22/22 0.00 18.00 0.00 0.00 0.00 18.00 Page 13 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr Karla A Parkhurst DC 09/29/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/05/22 10/05/22 0.00 21.33 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 08/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 09/07/22 09/07/22 0.00 0.00 21.33 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 10/28/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 21.33 0.00 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 09/16/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 09/22/22 09/22/22 0.00 21.33 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 10/12/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/17/22 10/17/22 21.33 0.00 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 07/13/22 97110-GP-97 - Therapy- Therapeutic Exercise No 07/18/22 10/17/22 0.00 0.00 0.00 23.10 0.00 23.10 Provider: Dr Karla A Parkhurst DC 07/13/22 97032-GP-59-97 - Therapy - E-Stim Attended No 07/18/22 10/17/22 0.00 0.00 0.00 18.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 07/06/22 98941-AT - Manipulation 3-4 Regions No 07/11/22 10/05/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 07/20/22 98941-AT - Manipulation 3-4 Regions No 07/25/22 10/05/22 0.00 0.00 0.00 34.28 0.00 34.28 Provider: Dr Karla A Parkhurst DC 07/06/22 99212-25 - Established Patient Exam - 10-19 Min No 07/11/22 10/05/22 0.00 0.00 0.00 0.00 23.05 23.05 Provider: Dr Karla A Parkhurst DC 07/20/22 99212-25 - Established Patient Exam - 10-19 Min No 07/25/22 10/05/22 0.00 0.00 0.00 23.05 0.00 23.05 Provider: Dr Karla A Parkhurst DC 07/13/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 07/18/22 10/17/22 0.00 0.00 0.00 21.33 0.00 21.33 Provider: Dr Karla A Parkhurst DC Patient Totals: 159.14 193.42 96.71 119.76 57.33 626.36 CUNFR000 Cunningham, Fredrick Group: 00283150 DOB: 12/23/1981 Insured ID: XYH918543243 09/13/22 97032-GP-59-97 - Therapy - E-Stim Attended No 09/14/22 09/14/22 0.00 18.00 0.00 0.00 0.00 18.00 Provider: Dr Russell Sweet DC 09/13/22 97110-GP-97 - No 09/14/22 09/14/22 0.00 23.10 0.00 0.00 0.00 23.10 Page 14 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Therapy- Therapeutic Exercise Provider: Dr Russell Sweet DC 09/13/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 09/14/22 09/14/22 0.00 21.33 0.00 0.00 0.00 21.33 Provider: Dr Russell Sweet DC Patient Totals: 0.00 62.43 0.00 0.00 0.00 62.43 DAREL000 Dargis, Elizabeth Group: 00275729 DOB: 10/24/1970 Insured ID: XYS921748509 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 22.99 0.00 0.00 0.00 0.00 22.99 Provider: Dr James Friess DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 22.99 0.00 0.00 0.00 0.00 22.99 Provider: Dr James Friess DC Patient Totals: 45.98 0.00 0.00 0.00 0.00 45.98 ELSJA000 Elston, Jason Group: 00609563 DOB: 02/12/1976 Insured ID: XYW919105625 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 30.85 0.00 0.00 0.00 0.00 30.85 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 30.85 0.00 0.00 0.00 0.00 30.85 Provider: Dr Brian S Parkhurst DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 41.58 0.00 0.00 0.00 0.00 41.58 Provider: Dr Brian S Parkhurst DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 41.58 0.00 0.00 0.00 0.00 41.58 Provider: Dr Brian S Parkhurst DC Patient Totals: 144.86 0.00 0.00 0.00 0.00 144.86 ELSJE001 Elston, Jennifer, M Group: 00609563 DOB: 11/13/1973 Insured ID: XYW919105625 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 20.79 0.00 0.00 0.00 0.00 20.79 Provider: Dr Karla A Parkhurst DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 41.38 0.00 0.00 0.00 0.00 41.38 Provider: Dr Karla A Parkhurst DC 10/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 19.20 0.00 0.00 0.00 0.00 19.20 Provider: Dr Karla A Parkhurst DC Patient Totals: 81.37 0.00 0.00 0.00 0.00 81.37 HARWI000 Harrington, William , T Group: 00276603 DOB: 01/21/1970 Insured ID: XYH898195610 10/21/22 98941-AT - Manipulation 3-4 No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Page 15 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Regions Provider: Dr Jeremy Lengkeek DC Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 HAWDO000 Hawkins, Dominique Group: 00009214 DOB: 03/30/2001 Insured ID: XYHM09546994 09/21/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 34.28 0.00 0.00 0.00 34.28 Provider: Dr Brian S Parkhurst DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/07/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 17.14 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/04/22 98941-AT - Manipulation 3-4 Regions No 10/10/22 10/10/22 0.00 17.14 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 17.14 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 09/21/22 99213-25 - Established Patient Exam - 20-29 Min No 10/03/22 10/03/22 0.00 53.25 0.00 0.00 0.00 53.25 Provider: Dr Brian S Parkhurst DC Patient Totals: 119.98 138.95 0.00 0.00 0.00 258.93 JONME000 Jones, Melissa Group: 00281401 DOB: 06/17/1983 Insured ID: XYH912467556 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 22.99 0.00 0.00 0.00 0.00 22.99 Provider: Dr James Friess DC 10/27/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 22.99 0.00 0.00 0.00 0.00 22.99 Page 16 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr James Friess DC Patient Totals: 45.98 0.00 0.00 0.00 0.00 45.98 MAASA001 Maas, Sandra Group: 00100582 DOB: 11/14/1960 Insured ID: XYS926479782 03/17/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/25/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 03/02/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/07/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 03/14/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Matthew Meiste DC 03/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Matthew Meiste DC 02/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/03/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 03/07/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/10/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 02/21/22 98941-AT - Manipulation 3-4 Regions No 03/03/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 03/02/22 98941-AT - Manipulation 3-4 Regions No 03/07/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 03/14/22 98941-AT - Manipulation 3-4 Regions No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Matthew Meiste DC 03/07/22 98941-AT - Manipulation 3-4 Regions No 03/10/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 03/10/22 98941-AT - Manipulation 3-4 Regions No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Matthew Meiste DC 03/17/22 98941-AT - Manipulation 3-4 Regions No 03/25/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 02/21/22 99202-25 - New Patient Exam - 15- 29 Min No 03/03/22 10/26/22 0.00 0.00 0.00 0.00 45.42 45.42 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 288.30 288.30 MALJU000 Malone, Julia Group: 00291654 Page 17 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
DOB: 03/25/1965 Insured ID: XYW920762794 12/03/21 98941-AT - Manipulation 3-4 Regions No 12/07/21 10/26/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 12/16/21 98941-AT - Manipulation 3-4 Regions No 12/21/21 10/26/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 12/27/21 98941-AT - Manipulation 3-4 Regions No 12/30/21 10/26/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 09/23/22 98942-AT - Manipulation 5 Regions No 09/29/22 10/26/22 0.00 20.00 0.00 0.00 0.00 20.00 Provider: Dr Karla A Parkhurst DC 09/19/22 98942-AT - Manipulation 5 Regions No 09/22/22 10/26/22 0.00 20.00 0.00 0.00 0.00 20.00 Provider: Dr Karla A Parkhurst DC 09/16/22 98942-AT - Manipulation 5 Regions No 09/22/22 10/26/22 0.00 20.00 0.00 0.00 0.00 20.00 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 60.00 0.00 0.00 102.84 162.84 ROBMA000 Roberts, Matthew Group: 00111161 DOB: 09/17/1982 Insured ID: XYH917659289 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 23.10 0.00 0.00 0.00 0.00 23.10 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC Patient Totals: 57.38 0.00 0.00 0.00 0.00 57.38 SCHJI000 Schutte, Jill Group: 00167361 DOB: 04/13/1990 Insured ID: XYHM07064803 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 34.28 0.00 0.00 0.00 0.00 34.28 Provider: Dr Russell Sweet DC Patient Totals: 34.28 0.00 0.00 0.00 0.00 34.28 SCRMI000 Scripps, Michelle Group: 00285241 DOB: 02/06/1981 Insured ID: XYHM07622539 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr James Friess DC Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 VALLA000 Vall, Laurie, A Group: 00187213 DOB: 09/15/1967 Insured ID: XYH892732269 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Karla A Parkhurst DC Page 18 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 VANAS000 Vanslooten, Ashley Group: 00285687 DOB: 02/24/1987 Insured ID: XYH925868229 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Karla A Parkhurst DC Patient Totals: 34.28 0.00 0.00 0.00 0.00 34.28 WYSCH000 Wysong, Christopher Group: 00224582 DOB: 07/24/1965 Insured ID: XYH894197710 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 36.78 0.00 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC 10/07/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 0.00 36.78 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 36.78 0.00 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 36.78 0.00 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC Patient Totals: 110.34 36.78 0.00 0.00 0.00 147.12 Carrier Totals: 993.70 491.58 96.71 142.19 517.77 2,241.95 Blue Care Network - Advantage 800-450-3680 HARBR000 Harmon, Bruce Group: 00275566 DOB: 06/10/1956 Insured ID: XYK993609568 10/14/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr James Friess DC Patient Totals: 31.35 0.00 0.00 0.00 0.00 31.35 HARJA001 Harper, James Group: 00275566 DOB: 03/17/1949 Insured ID: XYK891592068 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 19.10 0.00 0.00 0.00 0.00 19.10 Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.10 0.00 0.00 0.00 0.00 19.10 HERAM000 Herrera, Amparo Group: 00275566 DOB: 05/26/1942 Insured ID: XYK992254343 09/15/22 98941-AT - Manipulation 3-4 Regions No 09/22/22 09/22/22 0.00 19.71 0.00 0.00 0.00 19.71 Provider: Dr Karla A Parkhurst DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr Karla A Parkhurst DC Patient Totals: 19.71 19.71 0.00 0.00 0.00 39.42 KRANA000 Kraak, Nancy, L Group: 00275566 DOB: 06/11/1949 Insured ID: XYK992287055 10/28/22 98941-AT - No 11/03/22 11/03/22 19.10 0.00 0.00 0.00 0.00 19.10 Page 19 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Manipulation 3-4 Regions Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.10 0.00 0.00 0.00 0.00 19.10 MARCO000 Marques, Cora Group: 00275566 DOB: 10/07/1945 Insured ID: XYK894277254 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.71 0.00 0.00 0.00 0.00 19.71 MCGLE000 McGowan, Leslie, H Group: 00275566 DOB: 05/09/1955 Insured ID: XYK993521282 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr James Friess DC Patient Totals: 19.71 0.00 0.00 0.00 0.00 19.71 SHAHO000 Shank, Holly Group: 00275566 DOB: 12/26/1949 Insured ID: XYK918807751 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr James Friess DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr James Friess DC Patient Totals: 39.42 0.00 0.00 0.00 0.00 39.42 TAYCH000 Taylor, Christine, C Group: 00275566 DOB: 03/25/1957 Insured ID: XYK993577545 10/13/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr Karla A Parkhurst DC Patient Totals: 19.71 0.00 0.00 0.00 0.00 19.71 VANJI000 VanDam, Jill Group: 00275566 DOB: 05/04/1951 Insured ID: XYK992898693 10/31/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Samantha J Spooner DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/07/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/10/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 09/29/22 98942-AT - Manipulation 5 Regions No 10/05/22 10/05/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC Page 20 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
09/26/22 98942-AT - Manipulation 5 Regions No 09/29/22 09/29/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/13/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 09/22/22 98942-AT - Manipulation 5 Regions No 09/29/22 09/29/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC Patient Totals: 188.10 125.40 0.00 0.00 0.00 313.50 WISSA000 Wissink, Sally Group: 00275566 DOB: 04/12/1959 Insured ID: XYK911992677 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 19.55 0.00 0.00 0.00 0.00 19.55 Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.55 0.00 0.00 0.00 0.00 19.55 Carrier Totals: 395.46 145.11 0.00 0.00 0.00 540.57 Blue Cross Blue Shield BEHJE000 Behrendt, Jeanine Group: 71453 DOB: 06/30/1969 Insured ID: MMJ892419700 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Karla A Parkhurst DC Patient Totals: 130.26 0.00 0.00 0.00 0.00 130.26 BOWCA000 Bowen, Cara Group: 71453 DOB: 05/02/1986 Insured ID: MMJ911741218 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/21/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 BURHE000 Burleson, Heather Group: 71452 DOB: 01/18/1986 Insured ID: MMJ916375238 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 CHAAL000 Chatten, Alison Group: 71453 DOB: 05/12/1992 Insured ID: MMJ923197183 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Karla A Parkhurst DC Page 21 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Karla A Parkhurst DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 DYKCL000 Dykhouse, Clayton Group: 71453 DOB: 03/06/2001 Insured ID: MMJ892728153 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 FENMI001 Fenlon, Mirra Group: 71453 DOB: 10/10/2007 Insured ID: MMJ890750273 12/17/21 98941-AT - Manipulation 3-4 Regions No 12/21/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Brian S Parkhurst DC 12/20/21 98941-AT - Manipulation 3-4 Regions No 12/24/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Brian S Parkhurst DC 12/13/21 98941-AT - Manipulation 3-4 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Brian S Parkhurst DC 12/10/21 98941-AT - Manipulation 3-4 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Russell Sweet DC Patient Totals: 0.00 0.00 0.00 0.00 166.00 166.00 GRADA000 Grassmid, Danielle Group: 71453 DOB: 09/22/1987 Insured ID: MMJ913317894 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 16.06 0.00 0.00 0.00 16.06 Provider: Dr James Friess DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr James Friess DC 09/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/03/22 10/03/22 0.00 66.50 0.00 0.00 0.00 66.50 Provider: Dr James Friess DC 06/08/22 98942-AT - Manipulation 5 Regions No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 56.97 56.97 Provider: Dr James Friess DC 06/08/22 97012-GP - Therapy- Traction/Mechanical No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 16.12 16.12 Provider: Dr James Friess DC Page 22 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
06/08/22 97124-59-GP - Therapeutic Massage w/AIS No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 49.50 49.50 Provider: Dr James Friess DC 06/16/22 97124-59-GP - Therapeutic Massage w/AIS No 06/23/22 10/05/22 0.00 0.00 0.00 0.00 49.50 49.50 Provider: Dr James Friess DC 06/16/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/23/22 10/05/22 0.00 0.00 0.00 0.00 32.60 32.60 Provider: Dr James Friess DC 06/08/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 32.60 32.60 Provider: Dr James Friess DC Patient Totals: 130.26 82.56 0.00 0.00 237.29 450.11 GRARO001 Grassmid, Robert Group: 71453 DOB: 04/23/2022 Insured ID: MMJ913317894 07/27/22 99202-25 - New Patient Exam - 15- 29 Min No 08/01/22 10/05/22 0.00 0.00 0.00 89.83 0.00 89.83 Provider: Dr James Friess DC 07/27/22 98940-AT - Manipulation 1-2 Regions No 08/01/22 10/05/22 0.00 0.00 0.00 30.97 0.00 30.97 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 120.80 0.00 120.80 GREKA000 Greene, Kathryn Group: 71565 DOB: 03/27/1978 Insured ID: WYOM09024247 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 14.76 0.00 0.00 0.00 0.00 14.76 Provider: Dr James Friess DC 10/20/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 66.51 0.00 0.00 0.00 0.00 66.51 HESCH000 Hester, Charles, O Group: 072378 DOB: 12/20/1965 Insured ID: RYD834549262 01/17/22 98942-AT - Manipulation 5 Regions No 01/20/22 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr James Friess DC 12/15/21 98941-AT - Manipulation 3-4 Regions No 12/21/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/13/21 98941-AT - Manipulation 3-4 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/01/21 98941-AT - Manipulation 3-4 Regions No 12/07/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/09/21 98941-AT - Manipulation 3-4 Regions No 12/14/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Page 23 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr Matthew Meiste DC 12/07/21 98941-AT - Manipulation 3-4 Regions No 12/10/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/03/21 98941-AT - Manipulation 3-4 Regions No 12/07/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Russell Sweet DC 12/20/21 98941-AT - Manipulation 3-4 Regions No 12/24/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 01/03/22 98941-AT - Manipulation 3-4 Regions No 01/07/22 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 11/23/21 99202-25 - New Patient Exam - 15- 29 Min No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Matthew Meiste DC 11/23/21 72040 - X-ray Cervical Spine - 2-3 Views No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 62.85 62.85 Provider: Dr Matthew Meiste DC 11/23/21 72070 - X-ray Thoracic Spine - 2-3 Views No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 51.92 51.92 Provider: Dr Matthew Meiste DC 11/23/21 72100 - X-ray Lumbosacral 2-3 Views No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 63.40 63.40 Provider: Dr Matthew Meiste DC Patient Totals: 0.00 0.00 0.00 0.00 383.17 383.17 HOETO000 Hoeker, Tobi Group: 71453 DOB: 01/29/1979 Insured ID: MMJ892425427 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 HOLCO000 Holtrust, Conner Group: 71565 DOB: 06/17/2001 Insured ID: WYO891403313 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Karla A Parkhurst DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 JANMA000 Janicik, Marissa Group: 71453 DOB: 10/15/1983 Insured ID: MMJ917944880 Page 24 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/28/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Russell Sweet DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Russell Sweet DC Patient Totals: 294.10 0.00 0.00 0.00 0.00 294.10 JOHDA000 Johnston, David Group: 71453 DOB: 08/10/1969 Insured ID: MMJ893146867 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Brian S Parkhurst DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 JONLE000 Jones, Lee Ann Group: 71452 DOB: 02/14/1965 Insured ID: MMJ891828325 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 KREKR000 Krefeld Freier, Krista Group: 71565 DOB: 08/19/1969 Insured ID: WYO893053461 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC 10/27/22 97110-GP-97 - Therapy- Therapeutic No 11/03/22 11/03/22 14.76 0.00 0.00 0.00 0.00 14.76 Page 25 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Exercise Provider: Dr Karla A Parkhurst DC 10/27/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Karla A Parkhurst DC Patient Totals: 92.87 0.00 0.00 0.00 0.00 92.87 KROBR000 Kropscott, Brysen, R Group: 71453 DOB: 09/10/2014 Insured ID: MMJ911630343 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC Patient Totals: 92.72 0.00 0.00 0.00 0.00 92.72 KRODA001 Kropscott, David Group: 71453 DOB: 05/08/1983 Insured ID: MMJ911630343 10/31/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr James Friess DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr James Friess DC 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC Patient Totals: 294.10 0.00 0.00 0.00 0.00 294.10 KROHE000 Kropscott, Heather Group: 71453 DOB: 03/01/1983 Insured ID: MMJ911630343 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/27/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 121.48 0.00 0.00 0.00 0.00 121.48 LACCH000 Lacny, Charles Group: 71453 DOB: 09/01/2005 Insured ID: MMJ891213482 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Page 26 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr Jeremy Lengkeek DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 LECCH000 Leclair, Christopher Group: 71453 DOB: 12/20/1983 Insured ID: MMJ917212174 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Brian S Parkhurst DC 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Brian S Parkhurst DC Patient Totals: 149.66 0.00 0.00 0.00 0.00 149.66 STACO000 Leeuwenburg, Courtney Group: 71453 DOB: 10/20/1989 Insured ID: MMJ922520202 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 149.66 0.00 0.00 0.00 0.00 149.66 MAITI000 Maillet, Timothy Group: 049218 DOB: 03/28/1983 Insured ID: YAQ869210946M 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 32.45 0.00 0.00 0.00 0.00 32.45 Provider: Dr Jeremy Lengkeek DC Patient Totals: 32.45 0.00 0.00 0.00 0.00 32.45 MELCH000 Melvin , Christine Group: 71453 DOB: 09/03/1997 Insured ID: MMJ923085425 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC 10/17/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC Page 27 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/10/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/12/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/14/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/12/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/10/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/27/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/14/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/27/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/10/22 72040 - X-ray Cervical Spine - 2-3 Views No 10/24/22 10/24/22 70.63 0.00 0.00 0.00 0.00 70.63 Provider: Dr James Friess DC 10/10/22 72070 - X-ray Thoracic Spine - 2-3 Views No 10/24/22 10/24/22 58.67 0.00 0.00 0.00 0.00 58.67 Provider: Dr James Friess DC 10/10/22 72100 - X-ray Lumbosacral 2-3 Views No 10/24/22 10/24/22 71.23 0.00 0.00 0.00 0.00 71.23 Provider: Dr James Friess DC 10/10/22 99203-25 - New Patient Exam - 30- 44 Min No 10/24/22 10/24/22 132.96 0.00 0.00 0.00 0.00 132.96 Provider: Dr James Friess DC 10/27/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 856.42 0.00 0.00 0.00 0.00 856.42 MULHE000 Mulder, Heather Group: 71565 DOB: 12/09/1965 Insured ID: WYO890772291 Page 28 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 54.67 0.00 0.00 0.00 0.00 54.67 Provider: Dr James Friess DC Patient Totals: 54.67 0.00 0.00 0.00 0.00 54.67 MULPA000 Mulder, Paul Group: 71565 DOB: 03/10/1966 Insured ID: WYO890772291 10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 15.11 0.00 0.00 0.00 0.00 15.11 Provider: Dr James Friess DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 41.72 0.00 0.00 0.00 0.00 41.72 Provider: Dr James Friess DC Patient Totals: 56.83 0.00 0.00 0.00 0.00 56.83 MUMGA000 Mummert, Gabrielle Group: 000071565 DOB: 03/06/1997 Insured ID: WYO922692008 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC 10/12/22 98941-AT - Manipulation 3-4 Regions No 10/17/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC 10/05/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/10/22 10/20/22 0.00 69.52 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/12/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/17/22 10/20/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC Patient Totals: 301.28 69.52 0.00 0.00 0.00 370.80 NGUTA000 Nguyen, Tammy Group: 71452 DOB: 08/31/1972 Insured ID: MMJ890049963 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/19/22 97124-59-GP - Therapeutic Massage w/AIS No 10/24/22 10/24/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 Page 29 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
PATJU000 Paterick, Julie Group: 71453 DOB: 06/17/1975 Insured ID: MMJ891962454 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/20/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 PERDI000 Perez, Diane Group: 74153 DOB: 06/09/1963 Insured ID: MMJ890306138 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/09/22 11/09/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 PRIBR000 Prieditis, Bradley Group: 71453 DOB: 08/24/1972 Insured ID: MMJ894544304 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Russell Sweet DC Patient Totals: 132.67 0.00 0.00 0.00 0.00 132.67 STOMA000 Stout, Matthew Group: 71453 DOB: 05/28/1988 Insured ID: MMJ922632308 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/24/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 STOMI000 Stout, Micah Group: 71453 DOB: 11/24/2021 Insured ID: MMJ922632308 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 Page 30 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
TAYJE000 Taylor, Jennifer Group: 71453 DOB: 01/10/1972 Insured ID: MMJ894410152 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/28/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 TAYMA000 Taylor, Margaret Group: 71453 DOB: 09/21/2007 Insured ID: MMJ894410152 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/18/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 VANSU003 Vanderbilt, Susan Group: 71453 DOB: 11/23/1969 Insured ID: MMJ892603982 10/21/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/25/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/25/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/19/22 72070 - X-ray Thoracic Spine - 2-3 Views No 10/24/22 10/24/22 58.67 0.00 0.00 0.00 0.00 58.67 Provider: Dr Russell Sweet DC 10/19/22 72100 - X-ray No 10/24/22 10/24/22 71.23 0.00 0.00 0.00 0.00 71.23 Page 31 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Lumbosacral 2-3 Views Provider: Dr Russell Sweet DC 10/19/22 99203-25 - New Patient Exam - 30- 44 Min No 10/24/22 10/24/22 132.96 0.00 0.00 0.00 0.00 132.96 Provider: Dr Russell Sweet DC 10/21/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 34.50 0.00 0.00 0.00 0.00 34.50 Provider: Dr Russell Sweet DC 10/19/22 72040 - X-ray Cervical Spine - 2-3 Views No 10/24/22 10/24/22 70.63 0.00 0.00 0.00 0.00 70.63 Provider: Dr Russell Sweet DC Patient Totals: 635.34 0.00 0.00 0.00 0.00 635.34 VANDO002 Vanderhulst, Dominic Group: 71453 DOB: 06/13/2007 Insured ID: MMJ891517239 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 VANKA004 Vanderhulst, Kaylie Group: 71453 DOB: 12/28/2004 Insured ID: MMJ891517239 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 VANAM003 Vandermeulen, Amanda Group: 71565 DOB: 08/12/1976 Insured ID: WYO894190112 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 60.74 0.00 0.00 0.00 0.00 60.74 VANBR003 Vandermeulen, Breslyn Group: 71565 DOB: 07/08/2013 Insured ID: WYO894190112 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 VANBR002 Vandermeulen, Brynlee Group: 71565 DOB: 03/23/2010 Insured ID: WYO894190112 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 VANCA000 Vanfaasen, Carl Group: 71453 DOB: 02/25/1970 Insured ID: MMJ892007429 Page 32 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/19/22 97124-59-GP - Therapeutic Massage w/AIS No 10/24/22 10/24/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 164.04 0.00 0.00 0.00 0.00 164.04 VANPA000 Vanfaasen, Pamela Group: 71453 DOB: 11/27/1973 Insured ID: MMJ892007429 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/28/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 MULKR000 VanKoevering, Kristen Group: 51565 DOB: 06/20/1997 Insured ID: WYO890772291 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 54.67 0.00 0.00 0.00 0.00 54.67 Provider: Dr James Friess DC Patient Totals: 54.67 0.00 0.00 0.00 0.00 54.67 VOSBR000 Voss, Bryan Group: DOB: 08/24/1970 Insured ID: MMJ891872817 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Jeremy Lengkeek DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC 10/24/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Jeremy Lengkeek DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 VOSJE000 Voss, Jenanne Group: 71453 DOB: 09/20/1970 Insured ID: MMJ891872817 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Karla A Parkhurst DC Page 33 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/28/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Karla A Parkhurst DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 VRIDE000 Vriesman, Deirdre Group: 71453 DOB: 02/19/1979 Insured ID: MMJ890604289 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/21/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 WELAN000 Welsh-Lloyd, Angela Group: 71453 DOB: 05/21/1975 Insured ID: MMJ891979060 12/22/21 97124-59-GP - Therapeutic Massage w/AIS No 12/30/21 10/26/22 0.00 0.00 0.00 0.00 47.25 47.25 Provider: Dr James Friess DC 12/22/21 97110-GP-97 - Therapy- Therapeutic Exercise No 12/30/21 10/26/22 0.00 0.00 0.00 0.00 31.12 31.12 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 0.00 78.37 78.37 WHIKA001 Whitmyer, Kati Group: 71453 DOB: 07/16/1978 Insured ID: MMJ892557352 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC 10/24/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Karla A Parkhurst DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 WHINA000 Whitmyer, Nathan Group: 71453 DOB: 12/24/1977 Insured ID: MMJ892557352 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Page 34 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr James Friess DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 WURBE000 Wurst, Beth Group: 71453 DOB: 09/03/1972 Insured ID: MMJ894072454 10/27/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/21/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC 10/27/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC 10/31/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 233.76 0.00 0.00 0.00 0.00 233.76 Carrier Totals: 6,570.75 152.08 0.00 120.80 864.83 7,708.46 Blue Cross Blue Shield ARNLA000 Arnett, Laura Group: 020422 DOB: 10/12/1965 Insured ID: CUY000495330 10/11/22 98941-AT - Manipulation 3-4 Regions No 10/17/22 10/17/22 31.36 0.00 0.00 0.00 0.00 31.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 31.36 0.00 0.00 0.00 0.00 31.36 BELTE000 Bellingar, Teresa, A Group: DOB: 06/14/1964 Insured ID: HAW920519136 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 30.74 0.00 0.00 0.00 0.00 30.74 Provider: Dr James Friess DC Patient Totals: 30.74 0.00 0.00 0.00 0.00 30.74 BENGA001 Benavidez, Gabriel Group: 007000562 DOB: 11/13/1977 Insured ID: MIG914411035 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/25/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC Page 35 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/21/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/26/22 10/26/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/21/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC Patient Totals: 222.99 0.00 0.00 0.00 0.00 222.99 BENNO000 Benavidez, Nora Group: 007000562 DOB: 09/15/1982 Insured ID: MIG914411035 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 09/30/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/18/22 11/03/22 0.00 34.76 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 09/30/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/18/22 11/03/22 0.00 17.18 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/31/22 97032-GP-59-97 - Therapy - E-Stim Attended No 11/03/22 11/03/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/31/22 10/31/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC 10/21/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 63.94 0.00 0.00 0.00 0.00 63.94 Provider: Dr Russell Sweet DC 09/30/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/18/22 11/03/22 0.00 31.97 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC 10/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC Patient Totals: 295.70 83.91 0.00 0.00 0.00 379.61 Page 36 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
BERRA000 Bergman, Rachelle Group: DOB: 10/20/1977 Insured ID: KQD3HZN14745300 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Karla A Parkhurst DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 BLYSA001 Blystra, Sara Group: 5803289-DC10 DOB: 02/17/1976 Insured ID: WGJ837762312 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 BOEBE000 Boetsma, Berrett Group: 5803289-DC10 DOB: 05/29/2009 Insured ID: WGJ835801799 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 92.72 0.00 0.00 0.00 0.00 92.72 BOEBR000 Boetsma, Brylee Group: 5803289-DC10 DOB: 09/22/2005 Insured ID: WGJ835801799 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 185.44 0.00 0.00 0.00 0.00 185.44 BOEJU000 Boetsma, Julie Group: 5803289-DC10 DOB: 11/02/1980 Insured ID: WGJ835801799 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Russell Sweet DC Patient Totals: 6.36 0.00 0.00 0.00 0.00 6.36 BOEMO000 Boeve, Monica Group: 71565 DOB: 12/06/1981 Insured ID: WYO911217444 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC Page 37 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/24/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 63.94 0.00 0.00 0.00 0.00 63.94 Provider: Dr James Friess DC Patient Totals: 159.44 0.00 0.00 0.00 0.00 159.44 BORKI000 Borri, Kimberly Group: W0088557 DOB: 08/06/1967 Insured ID: XEA910465013 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 21.36 0.00 0.00 0.00 0.00 21.36 Provider: Dr Karla A Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/26/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/31/22 10/31/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Karla A Parkhurst DC 10/26/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/31/22 10/31/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Karla A Parkhurst DC Patient Totals: 105.27 0.00 0.00 0.00 0.00 105.27 BORSA000 Borri, Samuel Group: W0088557 DOB: 07/14/1999 Insured ID: XEA910465013 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Jeremy Lengkeek DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Jeremy Lengkeek DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 21.36 0.00 0.00 0.00 0.00 21.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 110.40 0.00 0.00 0.00 0.00 110.40 BRABR000 Bradshaw, Britney Group: 201060M1A1 DOB: 06/11/1986 Insured ID: XRQ819W09165 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 BROME000 Brown, Melissa, J Group: 71565 DOB: 06/01/1968 Insured ID: WYO892628550 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 COMPA000 Compagner, Paula Group: 074224 DOB: 03/17/1968 Insured ID: YFE826441505 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Page 38 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr Karla A Parkhurst DC 10/19/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/24/22 10/24/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Karla A Parkhurst DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/19/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/24/22 10/24/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Karla A Parkhurst DC Patient Totals: 130.27 0.00 0.00 0.00 0.00 130.27 CONLI000 Conti, Lisa Group: 10567865 DOB: 12/22/1966 Insured ID: H6U104151946001 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Karla A Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Karla A Parkhurst DC Patient Totals: 92.67 0.00 0.00 0.00 0.00 92.67 COOLA000 Cook, Laura Group: 007017055 DOB: 12/19/1975 Insured ID: XYQ920739457 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/09/22 11/09/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 COYSU000 Coy, Susan Group: 007000562 DOB: 10/09/1973 Insured ID: MIG890788924 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC 10/28/22 97032-GP-59-97 - Therapy - E-Stim Attended No 11/03/22 11/03/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Karla A Parkhurst DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/28/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 43.94 0.00 0.00 0.00 0.00 43.94 Provider: Dr Karla A Parkhurst DC Page 39 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Patient Totals: 148.60 0.00 0.00 0.00 0.00 148.60 DALTO000 Dalman, Todd Group: 71350 DOB: 11/24/1968 Insured ID: RGI893455836 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/09/22 11/09/22 21.36 0.00 0.00 0.00 0.00 21.36 Provider: Dr Jeremy Lengkeek DC 10/18/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Jeremy Lengkeek DC 11/01/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/09/22 11/09/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Jeremy Lengkeek DC Patient Totals: 135.40 0.00 0.00 0.00 0.00 135.40 DAMCA000 Dampier, Caitlin Group: 71553 DOB: 03/18/1990 Insured ID: haw922576200 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/31/22 10/31/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/31/22 10/31/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC Patient Totals: 269.35 0.00 0.00 0.00 0.00 269.35 DAMMI000 Dampier, Michael Group: 000071553 DOB: 07/12/1985 Insured ID: HAW922576200 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Russell Sweet DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 No 10/26/22 10/26/22 16.36 0.00 0.00 0.00 0.00 16.36 Page 40 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Regions Provider: Dr Russell Sweet DC Patient Totals: 49.08 0.00 0.00 0.00 0.00 49.08 DELTR000 Dellavecchia, Tracey Group: 007004452 DOB: 12/28/1976 Insured ID: MJU916962311 04/22/22 98941-AT - Manipulation 3-4 Regions No 04/28/22 10/05/22 0.00 0.00 0.00 0.00 50.00 50.00 Provider: Dr Karla A Parkhurst DC 04/22/22 97012-GP - Therapy- Traction/Mechanical No 04/28/22 10/05/22 0.00 0.00 0.00 0.00 24.00 24.00 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 74.00 74.00 DEMMI000 Demott, Michelle Group: 270130MPD1 DOB: 04/06/1983 Insured ID: HFY972W07102 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC Patient Totals: 167.84 0.00 0.00 0.00 0.00 167.84 DEVGA000 DeVries, Gail Group: JWI003 DOB: 12/17/1965 Insured ID: LBN1229966MB 10/07/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 0.00 40.74 0.00 0.00 0.00 40.74 Provider: Dr James Friess DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 40.74 0.00 0.00 0.00 0.00 40.74 Provider: Dr Russell Sweet DC 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 40.74 0.00 0.00 0.00 0.00 40.74 Provider: Dr Russell Sweet DC Patient Totals: 81.48 40.74 0.00 0.00 0.00 122.22 DEVMI000 DeVries, Michael Group: 71792 DOB: 05/22/1996 Insured ID: SEE923300334 10/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/13/22 10/13/22 49.52 0.00 0.00 0.00 0.00 49.52 Provider: Dr James Friess DC Patient Totals: 49.52 0.00 0.00 0.00 0.00 49.52 DEWDA001 Dewaard, Damien Group: 71557 DOB: 07/30/2000 Insured ID: OLZ922650313 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr James Friess DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr James Friess DC Page 41 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 13.43 0.00 0.00 0.00 0.00 13.43 Provider: Dr James Friess DC 10/27/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 13.43 0.00 0.00 0.00 0.00 13.43 Provider: Dr James Friess DC Patient Totals: 101.04 0.00 0.00 0.00 0.00 101.04 DORPA000 Dorn, Paul Group: 007013084 DOB: 12/07/1973 Insured ID: XYQM61881196 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Jeremy Lengkeek DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 12.72 0.00 0.00 0.00 0.00 12.72 EAKKE000 Eakley, Kennedi Group: 71549 DOB: 04/24/2001 Insured ID: KMT892581274 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Jeremy Lengkeek DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 EAKTH000 Eakley, Thomas Group: 71549 DOB: 10/04/1968 Insured ID: KMT892581274 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Jeremy Lengkeek DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 ERSER000 Ersfeld, Ernest Group: 00935000070 DOB: 03/20/1943 Insured ID: NJX3HZN10213510 07/08/22 98942-AT - Manipulation 5 Regions No 07/13/22 10/05/22 0.00 0.00 0.00 0.00 10.18 10.18 Provider: Dr Brian S Parkhurst DC 08/08/22 98942-AT - Manipulation 5 Regions No 08/11/22 10/05/22 0.00 0.00 0.00 10.18 0.00 10.18 Provider: Dr James Friess DC 08/19/22 98942-AT - Manipulation 5 Regions No 08/25/22 09/26/22 0.00 0.00 10.18 0.00 0.00 10.18 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 10.18 10.18 10.18 30.54 ERSPA000 Ersfeld, Pamela Group: 00935000070 DOB: 02/22/1944 Insured ID: NJX3HZN99578530 09/19/22 98941-AT - Manipulation 3-4 Regions No 09/22/22 10/13/22 0.00 7.76 0.00 0.00 0.00 7.76 Provider: Dr Karla A Parkhurst DC 08/29/22 98941-AT - Manipulation 3-4 Regions No 09/01/22 09/29/22 0.00 0.00 7.76 0.00 0.00 7.76 Provider: Dr Karla A Parkhurst DC 06/20/22 98941-AT - Manipulation 3-4 Regions No 06/23/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Page 42 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr Karla A Parkhurst DC 06/27/22 98941-AT - Manipulation 3-4 Regions No 06/30/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 06/03/22 98941-AT - Manipulation 3-4 Regions No 06/09/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 05/26/22 98941-AT - Manipulation 3-4 Regions No 06/02/22 10/24/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 06/09/22 98941-AT - Manipulation 3-4 Regions No 06/16/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 06/13/22 98941-AT - Manipulation 3-4 Regions No 06/16/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 7.76 7.76 0.00 46.56 62.08 ESPPA000 Espinoza, Paul Group: 007047642 DOB: 11/26/1965 Insured ID: LFIM04107707 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr James Friess DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 FEGST000 Fegel, Stephanie Group: 007013084 DOB: 10/08/1987 Insured ID: XYQ914895601 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Jeremy Lengkeek DC 10/20/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/26/22 10/26/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Jeremy Lengkeek DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC 10/20/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Jeremy Lengkeek DC Patient Totals: 130.27 0.00 0.00 0.00 0.00 130.27 FRAJA001 Frazier, Ja-mariah Group: 71440 DOB: 08/22/2005 Insured ID: NHT922166138 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Brian S Parkhurst DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Brian S Parkhurst DC 10/24/22 97110-GP-97 - Therapy- Therapeutic No 10/26/22 10/26/22 29.52 0.00 0.00 0.00 0.00 29.52 Page 43 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Exercise Provider: Dr Brian S Parkhurst DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 29.52 0.00 0.00 0.00 0.00 29.52 Provider: Dr Brian S Parkhurst DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC Patient Totals: 105.34 0.00 0.00 0.00 0.00 105.34 GEMRE000 Gemmill, Rene Group: 71549 DOB: 02/02/1971 Insured ID: KMT891844716 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Russell Sweet DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 GEURY000 Geurink, Ryan Group: 270130MPD1 DOB: 08/03/1991 Insured ID: HFY857W07102 10/18/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/18/22 97124-59-GP - Therapeutic Massage w/AIS No 10/24/22 10/24/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 86.51 0.00 0.00 0.00 0.00 86.51 GIBJO000 Gibson, Joanne Group: 174208M8AE DOB: 09/17/1958 Insured ID: VWW318M87256 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 41.72 0.00 0.00 0.00 0.00 41.72 Provider: Dr Jeremy Lengkeek DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 41.72 0.00 0.00 0.00 0.00 41.72 Provider: Dr Jeremy Lengkeek DC Patient Totals: 83.44 0.00 0.00 0.00 0.00 83.44 GIBME000 Gibson, Melissa, J Group: 71372 DOB: 04/14/1986 Insured ID: MZO910970356 06/16/22 98941-AT - Manipulation 3-4 Regions No 06/23/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 06/15/22 98941-AT - Manipulation 3-4 Regions No 06/23/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 08/18/22 98941-AT - Manipulation 3-4 Regions No 08/25/22 09/12/22 0.00 0.00 25.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 08/05/22 98941-AT - Manipulation 3-4 Regions No 08/11/22 09/29/22 0.00 0.00 0.00 25.00 0.00 25.00 Page 44 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
Provider: Dr Karla A Parkhurst DC 07/22/22 98941-AT - Manipulation 3-4 Regions No 07/28/22 09/29/22 0.00 0.00 0.00 25.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 06/27/22 98941-AT - Manipulation 3-4 Regions No 06/30/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 06/22/22 98941-AT - Manipulation 3-4 Regions No 06/28/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 07/08/22 98941-AT - Manipulation 3-4 Regions No 07/13/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 08/31/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/26/22 0.00 0.00 25.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 09/14/22 98941-AT - Manipulation 3-4 Regions No 09/14/22 09/29/22 0.00 25.00 0.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 09/29/22 98941-AT - Manipulation 3-4 Regions No 10/05/22 10/24/22 0.00 25.00 0.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/31/22 25.00 0.00 0.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 06/15/22 99203-25 - New Patient Exam - 30- 44 Min No 06/23/22 09/29/22 0.00 0.00 0.00 0.00 63.84 63.84 Provider: Dr Karla A Parkhurst DC Patient Totals: 25.00 50.00 50.00 50.00 188.84 363.84 GOEAU001 Goerner, Aubrey Group: 197162 DOB: 12/02/1998 Insured ID: HJD829647380 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 GRAJE000 Gradler, Jessica Group: 213019M113 DOB: 03/29/2002 Insured ID: KEF160A24915 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr James Friess DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 GRARO000 Gradler, Roger Group: 213019M113 DOB: 09/11/2000 Insured ID: KEF160A24915 10/13/22 97012-GP - Therapy- Traction/Mechanical No 10/20/22 10/20/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/13/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 Page 45 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
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Iesco Bill.pdf
Iesco Bill.pdf
Iesco Bill.pdf
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Iesco Bill.pdf
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Iesco Bill.pdf
Iesco Bill.pdf
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Iesco Bill.pdf
Iesco Bill.pdf
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Iesco Bill.pdf
Iesco Bill.pdf
Iesco Bill.pdf
Iesco Bill.pdf
Iesco Bill.pdf
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Iesco Bill.pdf
Iesco Bill.pdf
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Iesco Bill.pdf
Iesco Bill.pdf
Iesco Bill.pdf
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Iesco Bill.pdf

  • 1. Parkhurst Chiropractic Life Center PLC 364 Garden Ave. Holland, MI 49424-8656 616-392-9500 office@parkhurstchiropractic.com Insurance Accounts Receivable Report All Dates Visit Date Charge Disputed First Billed Last Billed Aged 0 to 30 Aged 31 to 60 Aged 61 to 90 Aged 91 to 120 Aged 121+ Total Owed AARP Healthcare 800-523-5800 BOWBA000 Bowen, Barbara Group: DOB: 06/20/1949 Insured ID: 032773928-12 09/27/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/26/22 0.00 7.76 0.00 0.00 0.00 7.76 Provider: Dr Russell Sweet DC Patient Totals: 0.00 7.76 0.00 0.00 0.00 7.76 DROMA000 Drost, Marla Group: PLAN F DOB: 06/13/1947 Insured ID: 038536341-12 09/15/21 98942-AT - Manipulation 5 Regions No 09/21/21 10/21/22 0.00 0.00 0.00 0.00 10.27 10.27 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 10.27 10.27 LACRO000 Lacy, Rosemary Group: DOB: 01/17/1955 Insured ID: 343996195-12 07/25/22 98941-AT - Manipulation 3-4 Regions No 08/01/22 10/13/22 0.00 0.00 0.00 38.78 0.00 38.78 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.00 0.00 38.78 0.00 38.78 LANDE000 Lankheet, Dennis Group: DOB: 05/30/1938 Insured ID: 047560181-11 09/21/22 98941-AT - Manipulation 3-4 Regions No 09/26/22 10/24/22 0.00 7.76 0.00 0.00 0.00 7.76 Provider: Dr James Friess DC Patient Totals: 0.00 7.76 0.00 0.00 0.00 7.76 Carrier Totals: 0.00 15.52 0.00 38.78 10.27 64.57 AETNA 888-632-3862 AGAJE001 Agar, Jennifer Group: 469618-12-001 DOB: 07/03/1975 Insured ID: W211497084 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 29.14 0.00 0.00 0.00 0.00 29.14 Provider: Dr James Friess DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 29.14 0.00 0.00 0.00 0.00 29.14 Provider: Dr James Friess DC 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr James Friess DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr James Friess DC 10/25/22 97140-GP-59-97 - No 10/31/22 10/31/22 46.26 0.00 0.00 0.00 0.00 46.26 Page 1 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 2. Therapy-Manual (Trigger Point, Myofascial Release) Provider: Dr James Friess DC Patient Totals: 130.12 0.00 0.00 0.00 0.00 130.12 AGAJO001 Agar, Joshua Group: 46961812001 DOB: 07/23/2004 Insured ID: W211497084 10/18/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/24/22 10/24/22 46.26 0.00 0.00 0.00 0.00 46.26 Provider: Dr James Friess DC 09/23/22 98942-AT - Manipulation 5 Regions No 09/29/22 09/29/22 0.00 37.46 0.00 0.00 0.00 37.46 Provider: Dr James Friess DC Patient Totals: 46.26 37.46 0.00 0.00 0.00 83.72 BAREM000 Barry, Emily, R Group: 028390001400007 DOB: 03/01/2000 Insured ID: W223870061 09/19/22 72070 - X-ray Thoracic Spine - 2-3 Views No 09/29/22 09/29/22 0.00 56.50 0.00 0.00 0.00 56.50 Provider: Dr Russell Sweet DC 09/19/22 72100 - X-ray Lumbosacral 2-3 Views No 09/29/22 09/29/22 0.00 68.50 0.00 0.00 0.00 68.50 Provider: Dr Russell Sweet DC 09/19/22 72040 - X-ray Cervical Spine - 2-3 Views No 09/29/22 09/29/22 0.00 68.00 0.00 0.00 0.00 68.00 Provider: Dr Russell Sweet DC 10/04/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/05/22 10/05/22 0.00 14.06 0.00 0.00 0.00 14.06 Provider: Dr Russell Sweet DC Patient Totals: 0.00 207.06 0.00 0.00 0.00 207.06 BLOJO001 Bloemers, Jonathan Group: 477158-012-00006 DOB: 09/06/2005 Insured ID: W251105281 09/27/22 99202-25 - New Patient Exam - 15- 29 Min No 10/03/22 10/03/22 0.00 49.08 0.00 0.00 0.00 49.08 Provider: Dr Jeremy Lengkeek DC Patient Totals: 0.00 49.08 0.00 0.00 0.00 49.08 CRUAL000 Cruz, Alicia Group: 144124-020-00011 DOB: 07/23/1997 Insured ID: W265118909 10/13/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 29.14 0.00 0.00 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC 10/13/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/20/22 10/20/22 49.06 0.00 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC Patient Totals: 78.20 0.00 0.00 0.00 0.00 78.20 ECCRY000 Eccker, Ryan Group: 0326476-010-00143 DOB: 11/09/1995 Insured ID: W821333173 09/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/26/22 09/26/22 0.00 39.25 0.00 0.00 0.00 39.25 Provider: Dr Brian S Parkhurst DC Page 2 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 3. 09/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/26/22 09/26/22 0.00 39.25 0.00 0.00 0.00 39.25 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 78.50 0.00 0.00 0.00 78.50 FILSU000 Filipovic, Suvada Group: 469618-11-001 DOB: 09/01/1973 Insured ID: W168503278 09/21/22 97012-GP - Therapy- Traction/Mechanical No 09/26/22 09/26/22 0.00 0.25 0.00 0.00 0.00 0.25 Provider: Dr Karla A Parkhurst DC 09/23/22 97012-GP - Therapy- Traction/Mechanical No 09/29/22 09/29/22 0.00 0.25 0.00 0.00 0.00 0.25 Provider: Dr Karla A Parkhurst DC 09/30/22 97012-GP - Therapy- Traction/Mechanical No 10/05/22 10/05/22 0.00 0.25 0.00 0.00 0.00 0.25 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.75 0.00 0.00 0.00 0.75 HOFRO000 Hoffman, Robert Group: 608598-40-142 DOB: 12/18/1931 Insured ID: W013065253 07/18/22 98941-AT - Manipulation 3-4 Regions No 07/21/22 10/05/22 0.00 0.00 0.00 7.76 0.00 7.76 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 7.76 0.00 7.76 LAKJE000 Lake, Jennifer Group: 469618-10-001 DOB: 03/02/1983 Insured ID: W222460677 10/12/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/07/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/10/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/14/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC 10/17/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 12.79 0.00 0.00 0.00 0.00 12.79 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 49.06 0.00 0.00 0.00 0.00 49.06 Provider: Dr Karla A Parkhurst DC 10/14/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC Page 3 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 4. 10/12/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Russell Sweet DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/20/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Samantha J Spooner DC 10/10/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/07/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 0.00 37.46 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 10/07/22 99213-25 - Established Patient Exam - 20-29 Min No 10/31/22 10/31/22 0.00 58.27 0.00 0.00 0.00 58.27 Provider: Dr Karla A Parkhurst DC Patient Totals: 337.77 108.52 0.00 0.00 0.00 446.29 POLDE000 Pols, Debbie Group: 141987-10-001 DOB: 08/22/1964 Insured ID: W253365428 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 7.46 0.00 0.00 0.00 0.00 7.46 Provider: Dr James Friess DC 10/14/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 7.46 0.00 0.00 0.00 0.00 7.46 Provider: Dr James Friess DC Patient Totals: 14.92 0.00 0.00 0.00 0.00 14.92 RAMPA000 Ramos, Patty Group: 469618-12-001 DOB: 12/24/1965 Insured ID: W168503018 10/06/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 29.14 0.00 0.00 0.00 29.14 Provider: Dr James Friess DC Patient Totals: 0.00 29.14 0.00 0.00 0.00 29.14 ROMLU000 Romano, Luca Group: 285583-10-001 DOB: 08/31/2002 Insured ID: W254526006 08/17/22 97012-GP - Therapy- Traction/Mechanical No 08/22/22 10/05/22 0.00 0.00 12.79 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 09/01/22 97012-GP - Therapy- Traction/Mechanical No 09/07/22 09/07/22 0.00 0.00 12.79 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 09/14/22 97012-GP - Therapy- Traction/Mechanical No 09/19/22 09/19/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 08/05/22 97012-GP - Therapy- No 08/11/22 10/05/22 0.00 0.00 0.00 12.79 0.00 12.79 Page 4 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 5. Traction/Mechanical Provider: Dr Brian S Parkhurst DC 09/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/03/22 10/03/22 0.00 49.06 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 10/05/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/10/22 10/10/22 0.00 49.06 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 09/15/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/22/22 09/22/22 0.00 49.06 0.00 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/29/22 10/05/22 0.00 0.00 49.06 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 09/01/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/07/22 09/07/22 0.00 0.00 49.06 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/15/22 10/05/22 0.00 0.00 0.00 49.06 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/17/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/22/22 10/05/22 0.00 0.00 49.06 0.00 0.00 49.06 Provider: Dr Brian S Parkhurst DC 08/05/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/11/22 10/05/22 0.00 0.00 0.00 49.06 0.00 49.06 Provider: Dr Brian S Parkhurst DC 06/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/28/22 10/05/22 0.00 0.00 0.00 0.00 49.06 49.06 Provider: Dr Brian S Parkhurst DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Brian S Parkhurst DC 08/05/22 98941-AT - Manipulation 3-4 Regions No 08/11/22 10/05/22 0.00 0.00 0.00 29.14 0.00 29.14 Provider: Dr Brian S Parkhurst DC 08/17/22 98941-AT - Manipulation 3-4 Regions No 08/22/22 10/05/22 0.00 0.00 29.14 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC 09/01/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/07/22 0.00 0.00 29.14 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC 09/14/22 98941-AT - Manipulation 3-4 No 09/19/22 09/19/22 0.00 29.14 0.00 0.00 0.00 29.14 Page 5 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 6. Regions Provider: Dr Brian S Parkhurst DC 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 29.14 0.00 0.00 0.00 29.14 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 231.04 231.04 140.05 49.06 651.19 TAUGE000 Taubert, Gerald, T Group: 100008-02EG0009 DOB: 03/30/1949 Insured ID: 101235782100 06/06/22 98942-AT - Manipulation 5 Regions No 06/09/22 09/19/22 0.00 0.00 0.00 0.00 17.46 17.46 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 17.46 17.46 VANBR004 VanKley, Brian Group: 039363002700002 DOB: 12/13/1973 Insured ID: W273547226 05/25/22 98941-AT - Manipulation 3-4 Regions No 06/02/22 10/31/22 0.00 0.00 0.00 0.00 50.00 50.00 Provider: Dr Russell Sweet DC Patient Totals: 0.00 0.00 0.00 0.00 50.00 50.00 Carrier Totals: 607.27 741.55 231.04 147.81 116.52 1,844.19 AETNA 800-345-4061 MANTO000 Mannes, Tonya Group: 144124-020-00011 DOB: 02/25/1975 Insured ID: W257370741 09/21/22 97012-GP - Therapy- Traction/Mechanical No 09/26/22 09/26/22 0.00 11.93 0.00 0.00 0.00 11.93 Provider: Dr James Friess DC 10/10/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/13/22 10/13/22 8.42 0.00 0.00 0.00 0.00 8.42 Provider: Dr James Friess DC 10/03/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/10/22 10/10/22 0.00 8.42 0.00 0.00 0.00 8.42 Provider: Dr James Friess DC 10/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/13/22 10/13/22 24.53 0.00 0.00 0.00 0.00 24.53 Provider: Dr James Friess DC 10/03/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/10/22 10/10/22 0.00 24.53 0.00 0.00 0.00 24.53 Provider: Dr James Friess DC 10/03/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/10/22 10/10/22 0.00 16.26 0.00 0.00 0.00 16.26 Provider: Dr James Friess DC 10/10/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/13/22 10/13/22 16.26 0.00 0.00 0.00 0.00 16.26 Provider: Dr James Friess DC Patient Totals: 49.21 61.14 0.00 0.00 0.00 110.35 WEBLO000 Weber, Lori Group: 086867102500002 DOB: 06/01/1962 Insured ID: W263964144 10/04/22 72040 - X-ray Cervical Spine - 2-3 No 10/24/22 10/24/22 0.00 71.00 0.00 0.00 0.00 71.00 Page 6 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 7. Views Provider: Dr Russell Sweet DC 10/04/22 99203-25 - New Patient Exam - 30- 44 Min No 10/17/22 10/17/22 0.00 37.77 0.00 0.00 0.00 37.77 Provider: Dr Russell Sweet DC 10/04/22 72070 - X-ray Thoracic Spine - 2-3 Views No 10/24/22 10/24/22 0.00 59.00 0.00 0.00 0.00 59.00 Provider: Dr Russell Sweet DC 10/04/22 72100 - X-ray Lumbosacral 2-3 Views No 10/24/22 10/24/22 0.00 72.00 0.00 0.00 0.00 72.00 Provider: Dr Russell Sweet DC Patient Totals: 0.00 239.77 0.00 0.00 0.00 239.77 Carrier Totals: 49.21 300.91 0.00 0.00 0.00 350.12 AETNA Medicare / Managed Care HOLAR000 Holden, Ardice Group: DOB: 02/12/1950 Insured ID: MEBVNV8T 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 17.46 0.00 0.00 0.00 0.00 17.46 Provider: Dr James Friess DC 10/06/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 9.14 0.00 0.00 0.00 9.14 Provider: Dr James Friess DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 9.14 0.00 0.00 0.00 0.00 9.14 Provider: Dr James Friess DC Patient Totals: 26.60 9.14 0.00 0.00 0.00 35.74 MALJU000 Malone, Julia Group: DOB: 03/25/1965 Insured ID: 101549187600 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC 09/01/22 98942-AT - Manipulation 5 Regions No 09/07/22 09/07/22 0.00 0.00 37.46 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC Patient Totals: 37.46 0.00 37.46 0.00 0.00 74.92 MOOGE000 Moorman, George Group: 354647 DOB: 08/25/1955 Insured ID: MEBT44ZD 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 9.14 0.00 0.00 0.00 0.00 9.14 Provider: Dr Brian S Parkhurst DC Patient Totals: 9.14 0.00 0.00 0.00 0.00 9.14 RETMI000 Rettler, Mia Group: 467248 DOB: 05/03/1998 Insured ID: MEBT9VVT 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 37.46 0.00 0.00 0.00 0.00 37.46 Provider: Dr Karla A Parkhurst DC Patient Totals: 37.46 0.00 0.00 0.00 0.00 37.46 TEUAD000 Teunissen, Adrian Group: DOB: 06/30/1950 Insured ID: MEBS8JRP 10/26/22 98942-AT - Manipulation 5 No 10/31/22 10/31/22 17.46 0.00 0.00 0.00 0.00 17.46 Page 7 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 8. Regions Provider: Dr Brian S Parkhurst DC Patient Totals: 17.46 0.00 0.00 0.00 0.00 17.46 TEUBA000 Teunissen, Barbara Group: DOB: 06/02/1949 Insured ID: MEBS724P 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 17.46 0.00 0.00 0.00 0.00 17.46 Provider: Dr Brian S Parkhurst DC Patient Totals: 17.46 0.00 0.00 0.00 0.00 17.46 Carrier Totals: 145.58 9.14 37.46 0.00 0.00 192.18 AETNA PPO 800-231-7729 HILAB000 Hilleshiem, Abigail Group: 479260-013-00001 DOB: 07/12/1986 Insured ID: W206850727 03/08/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/14/22 10/21/22 0.00 0.00 0.00 0.00 21.71 21.71 Provider: Dr Russell Sweet DC 03/08/22 97124-59-GP - Therapeutic Massage w/AIS No 03/14/22 10/21/22 0.00 0.00 0.00 0.00 35.46 35.46 Provider: Dr Russell Sweet DC Patient Totals: 0.00 0.00 0.00 0.00 57.17 57.17 Carrier Totals: 0.00 0.00 0.00 0.00 57.17 57.17 AETNA PPO 888-632-3862 JOHNI000 Johns, Nicole Group: 144124-021-00011 DOB: 11/07/1980 Insured ID: W259496241 10/12/22 97012-GP - Therapy- Traction/Mechanical No 10/17/22 10/17/22 11.93 0.00 0.00 0.00 0.00 11.93 Provider: Dr Russell Sweet DC 09/21/22 97012-GP - Therapy- Traction/Mechanical No 09/26/22 09/26/22 0.00 11.93 0.00 0.00 0.00 11.93 Provider: Dr Russell Sweet DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 11.93 0.00 0.00 0.00 11.93 Provider: Dr Russell Sweet DC Patient Totals: 11.93 23.86 0.00 0.00 0.00 35.79 Carrier Totals: 11.93 23.86 0.00 0.00 0.00 35.79 AETNA US Healthcare 877-204-9064 ARRCA000 Arreola, Carrie Group: DOB: 09/22/1975 Insured ID: W263957898 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 29.14 0.00 0.00 0.00 29.14 Provider: Dr Karla A Parkhurst DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 12.79 0.00 0.00 0.00 12.79 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 41.93 0.00 0.00 0.00 41.93 GARAN000 Garza, Anita Group: 283912-040-00100 DOB: 03/19/1971 Insured ID: W235597891 10/13/22 97012-GP - Therapy- Traction/Mechanical No 10/20/22 10/20/22 1.93 0.00 0.00 0.00 0.00 1.93 Provider: Dr James Friess DC Page 8 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 9. 09/22/22 97012-GP - Therapy- Traction/Mechanical No 09/29/22 09/29/22 0.00 1.93 0.00 0.00 0.00 1.93 Provider: Dr James Friess DC Patient Totals: 1.93 1.93 0.00 0.00 0.00 3.86 LEMAV000 Lemire, Ava Group: 469618-12-001 DOB: 06/13/2008 Insured ID: W168501695 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/07/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 23.31 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 39.25 0.00 0.00 0.00 0.00 39.25 Provider: Dr Brian S Parkhurst DC Patient Totals: 109.18 23.31 0.00 0.00 0.00 132.49 LEMEL000 Lemire, Ellery Group: 469618-12-001 DOB: 06/29/2014 Insured ID: W168501695 09/22/22 98941-AT - Manipulation 3-4 Regions No 09/29/22 09/29/22 0.00 23.31 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 23.31 0.00 0.00 0.00 23.31 LEMRY000 Lemire, Ryan Group: 469618-12-001 DOB: 01/05/1977 Insured ID: W168501695 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 09/23/22 98941-AT - Manipulation 3-4 Regions No 09/29/22 09/29/22 0.00 23.31 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 23.31 0.00 0.00 0.00 0.00 23.31 Provider: Dr Brian S Parkhurst DC Patient Totals: 69.93 23.31 0.00 0.00 0.00 93.24 Carrier Totals: 181.04 113.79 0.00 0.00 0.00 294.83 AMERISURE INSURANCE 800-257-1900 CAVJE000 Cavanagh, Jeff Group: DOB: 02/03/1964 Insured ID: 588141 04/13/22 97012-GP - Therapy- Traction/Mechanical No 04/14/22 10/21/22 0.00 0.00 0.00 0.00 24.00 24.00 Page 9 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 10. Provider: Dr James Friess DC 04/13/22 98942-AT - Manipulation 5 Regions No 04/14/22 10/21/22 0.00 0.00 0.00 0.00 60.00 60.00 Provider: Dr James Friess DC 05/09/22 98942-AT - Manipulation 5 Regions No 05/12/22 10/21/22 0.00 0.00 0.00 0.00 60.00 60.00 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 0.00 144.00 144.00 Carrier Totals: 0.00 0.00 0.00 0.00 144.00 144.00 ASR Corporation 616-957-1751 MULAN000 Mulder, Anna Group: 1153 DOB: 10/13/1963 Insured ID: P0424938 11/23/21 98940-AT - Manipulation 1-2 Regions No 11/30/21 10/20/22 0.00 0.00 0.00 0.00 5.44 5.44 Provider: Dr Jeremy Lengkeek DC 12/14/21 98940-AT - Manipulation 1-2 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 5.44 5.44 Provider: Dr Jeremy Lengkeek DC Patient Totals: 0.00 0.00 0.00 0.00 10.88 10.88 Carrier Totals: 0.00 0.00 0.00 0.00 10.88 10.88 Auto Owners - Care Works 877-876-5621 HANLI000 Hanges, Lindsey Group: DOB: 05/02/1982 Insured ID: 0660005145-2010 10/25/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/21/22 10/21/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/17/22 10/17/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC 09/06/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/07/22 0.00 0.00 50.00 0.00 0.00 50.00 Provider: Dr Jeremy Lengkeek DC 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 37.52 0.00 0.00 0.00 0.00 37.52 Provider: Dr Jeremy Lengkeek DC Patient Totals: 150.08 0.00 50.00 0.00 0.00 200.08 HANTR000 Hanges, Travis Group: DOB: 04/24/1980 Insured ID: 066-0005145-2010 07/21/22 98941-AT - Manipulation 3-4 Regions No 07/28/22 10/21/22 0.00 0.00 0.00 50.00 0.00 50.00 Provider: Dr Jeremy Lengkeek DC 07/14/22 98941-AT - Manipulation 3-4 Regions No 07/21/22 10/21/22 0.00 0.00 0.00 50.00 0.00 50.00 Provider: Dr Jeremy Lengkeek DC 07/28/22 98941-AT - Manipulation 3-4 Regions No 08/04/22 11/07/22 0.00 0.00 0.00 36.72 0.00 36.72 Provider: Dr Jeremy Lengkeek DC Page 10 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 11. Patient Totals: 0.00 0.00 0.00 136.72 0.00 136.72 Carrier Totals: 150.08 0.00 50.00 136.72 0.00 336.80 BCBS Federal 800-482-3600 CHAMO000 Chartrand, Monica Group: 106 DOB: 01/21/1967 Insured ID: R59177250 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Brian S Parkhurst DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 61.00 0.00 0.00 0.00 0.00 61.00 Provider: Dr Brian S Parkhurst DC Patient Totals: 105.52 0.00 0.00 0.00 0.00 105.52 JEFJE000 Jefferson, Jeannie Group: DOB: 12/02/1979 Insured ID: R61200807 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 39.52 0.00 0.00 0.00 0.00 39.52 Provider: Dr Jeremy Lengkeek DC Patient Totals: 39.52 0.00 0.00 0.00 0.00 39.52 JEFMA000 Jefferson, Matthew, C Group: DOB: 01/19/1979 Insured ID: R61200807 10/25/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Jeremy Lengkeek DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 32.72 0.00 0.00 0.00 0.00 32.72 MCMSU000 McMahon, Susan Group: DOB: 10/26/1969 Insured ID: R60023002 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Russell Sweet DC Patient Totals: 16.36 0.00 0.00 0.00 0.00 16.36 MUSLI000 Musgrove, Linda Group: 112 DOB: 02/16/1952 Insured ID: R58717078 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Jeremy Lengkeek DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 4.76 0.00 0.00 0.00 0.00 4.76 Provider: Dr Jeremy Lengkeek DC 10/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 63.94 0.00 0.00 0.00 0.00 63.94 Provider: Dr Jeremy Lengkeek DC Patient Totals: 85.06 0.00 0.00 0.00 0.00 85.06 WOORO000 Woodburn, Ronald, K Group: 106 DOB: 07/16/1953 Insured ID: R22452158 10/25/21 97110-GP-97 - Therapy- No 03/28/22 10/20/22 0.00 0.00 0.00 0.00 68.00 68.00 Page 11 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 12. Therapeutic Exercise Provider: Dr Brian S Parkhurst DC 01/17/22 97110-GP-97 - Therapy- Therapeutic Exercise No 01/20/22 10/20/22 0.00 0.00 0.00 0.00 68.00 68.00 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 136.00 136.00 Carrier Totals: 279.18 0.00 0.00 0.00 136.00 415.18 Blue Care Network 800-255-1690 BALSA000 Bale, Sandra Group: 00285843 DOB: 05/09/1969 Insured ID: XYHM05471999 08/03/22 97110-GP-97 - Therapy- Therapeutic Exercise No 08/08/22 09/07/22 0.00 0.00 0.00 4.43 0.00 4.43 Provider: Dr Jeremy Lengkeek DC 08/03/22 97032-GP-59-97 - Therapy - E-Stim Attended No 08/08/22 09/07/22 0.00 0.00 0.00 18.00 0.00 18.00 Provider: Dr Jeremy Lengkeek DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Jeremy Lengkeek DC Patient Totals: 17.14 0.00 0.00 22.43 0.00 39.57 BARAD000 Barksdale, Adam Group: 00185486 DOB: 03/05/1977 Insured ID: XYH894807836 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 BIRTR000 Birce, Travis Group: 00276603 DOB: 07/17/1989 Insured ID: XYH916132241 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Jeremy Lengkeek DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Jeremy Lengkeek DC Patient Totals: 34.28 0.00 0.00 0.00 0.00 34.28 BUSJE000 Bush, Jean Group: 00285687 DOB: 06/28/1963 Insured ID: XYH891876401 10/19/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Karla A Parkhurst DC 06/22/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/28/22 10/05/22 0.00 0.00 0.00 0.00 69.30 69.30 Provider: Dr Karla A Parkhurst DC Patient Totals: 17.14 0.00 0.00 0.00 69.30 86.44 CALAL000 Calderon, Alexa Group: 00282466 DOB: 06/14/2004 Insured ID: XYH910419571 10/27/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 22.99 0.00 0.00 0.00 0.00 22.99 Page 12 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 13. Provider: Dr Karla A Parkhurst DC Patient Totals: 22.99 0.00 0.00 0.00 0.00 22.99 KURSA000 Cockrum, Sandra Group: 00172582 DOB: 07/26/1964 Insured ID: XYH890626054 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 34.28 0.00 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 09/16/22 98941-AT - Manipulation 3-4 Regions No 09/22/22 09/22/22 0.00 34.28 0.00 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 08/31/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/07/22 0.00 0.00 34.28 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 34.28 0.00 0.00 0.00 0.00 34.28 Provider: Dr Karla A Parkhurst DC 10/12/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/17/22 10/17/22 23.10 0.00 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 09/29/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/05/22 10/05/22 0.00 23.10 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 09/16/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/22/22 09/22/22 0.00 23.10 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 08/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 09/07/22 09/07/22 0.00 0.00 23.10 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 23.10 0.00 0.00 0.00 0.00 23.10 Provider: Dr Karla A Parkhurst DC 09/29/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/05/22 10/05/22 0.00 18.00 0.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 10/12/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/17/22 10/17/22 18.00 0.00 0.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 10/28/22 97032-GP-59-97 - Therapy - E-Stim Attended No 11/03/22 11/03/22 18.00 0.00 0.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 08/31/22 97032-GP-59-97 - Therapy - E-Stim Attended No 09/07/22 09/07/22 0.00 0.00 18.00 0.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 09/16/22 97032-GP-59-97 - Therapy - E-Stim Attended No 09/22/22 09/22/22 0.00 18.00 0.00 0.00 0.00 18.00 Page 13 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 14. Provider: Dr Karla A Parkhurst DC 09/29/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/05/22 10/05/22 0.00 21.33 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 08/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 09/07/22 09/07/22 0.00 0.00 21.33 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 10/28/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 21.33 0.00 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 09/16/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 09/22/22 09/22/22 0.00 21.33 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 10/12/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/17/22 10/17/22 21.33 0.00 0.00 0.00 0.00 21.33 Provider: Dr Karla A Parkhurst DC 07/13/22 97110-GP-97 - Therapy- Therapeutic Exercise No 07/18/22 10/17/22 0.00 0.00 0.00 23.10 0.00 23.10 Provider: Dr Karla A Parkhurst DC 07/13/22 97032-GP-59-97 - Therapy - E-Stim Attended No 07/18/22 10/17/22 0.00 0.00 0.00 18.00 0.00 18.00 Provider: Dr Karla A Parkhurst DC 07/06/22 98941-AT - Manipulation 3-4 Regions No 07/11/22 10/05/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 07/20/22 98941-AT - Manipulation 3-4 Regions No 07/25/22 10/05/22 0.00 0.00 0.00 34.28 0.00 34.28 Provider: Dr Karla A Parkhurst DC 07/06/22 99212-25 - Established Patient Exam - 10-19 Min No 07/11/22 10/05/22 0.00 0.00 0.00 0.00 23.05 23.05 Provider: Dr Karla A Parkhurst DC 07/20/22 99212-25 - Established Patient Exam - 10-19 Min No 07/25/22 10/05/22 0.00 0.00 0.00 23.05 0.00 23.05 Provider: Dr Karla A Parkhurst DC 07/13/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 07/18/22 10/17/22 0.00 0.00 0.00 21.33 0.00 21.33 Provider: Dr Karla A Parkhurst DC Patient Totals: 159.14 193.42 96.71 119.76 57.33 626.36 CUNFR000 Cunningham, Fredrick Group: 00283150 DOB: 12/23/1981 Insured ID: XYH918543243 09/13/22 97032-GP-59-97 - Therapy - E-Stim Attended No 09/14/22 09/14/22 0.00 18.00 0.00 0.00 0.00 18.00 Provider: Dr Russell Sweet DC 09/13/22 97110-GP-97 - No 09/14/22 09/14/22 0.00 23.10 0.00 0.00 0.00 23.10 Page 14 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 15. Therapy- Therapeutic Exercise Provider: Dr Russell Sweet DC 09/13/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 09/14/22 09/14/22 0.00 21.33 0.00 0.00 0.00 21.33 Provider: Dr Russell Sweet DC Patient Totals: 0.00 62.43 0.00 0.00 0.00 62.43 DAREL000 Dargis, Elizabeth Group: 00275729 DOB: 10/24/1970 Insured ID: XYS921748509 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 22.99 0.00 0.00 0.00 0.00 22.99 Provider: Dr James Friess DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 22.99 0.00 0.00 0.00 0.00 22.99 Provider: Dr James Friess DC Patient Totals: 45.98 0.00 0.00 0.00 0.00 45.98 ELSJA000 Elston, Jason Group: 00609563 DOB: 02/12/1976 Insured ID: XYW919105625 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 30.85 0.00 0.00 0.00 0.00 30.85 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 30.85 0.00 0.00 0.00 0.00 30.85 Provider: Dr Brian S Parkhurst DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 41.58 0.00 0.00 0.00 0.00 41.58 Provider: Dr Brian S Parkhurst DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 41.58 0.00 0.00 0.00 0.00 41.58 Provider: Dr Brian S Parkhurst DC Patient Totals: 144.86 0.00 0.00 0.00 0.00 144.86 ELSJE001 Elston, Jennifer, M Group: 00609563 DOB: 11/13/1973 Insured ID: XYW919105625 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 20.79 0.00 0.00 0.00 0.00 20.79 Provider: Dr Karla A Parkhurst DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 41.38 0.00 0.00 0.00 0.00 41.38 Provider: Dr Karla A Parkhurst DC 10/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 19.20 0.00 0.00 0.00 0.00 19.20 Provider: Dr Karla A Parkhurst DC Patient Totals: 81.37 0.00 0.00 0.00 0.00 81.37 HARWI000 Harrington, William , T Group: 00276603 DOB: 01/21/1970 Insured ID: XYH898195610 10/21/22 98941-AT - Manipulation 3-4 No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Page 15 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 16. Regions Provider: Dr Jeremy Lengkeek DC Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 HAWDO000 Hawkins, Dominique Group: 00009214 DOB: 03/30/2001 Insured ID: XYHM09546994 09/21/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 34.28 0.00 0.00 0.00 34.28 Provider: Dr Brian S Parkhurst DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/07/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 0.00 17.14 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/13/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/04/22 98941-AT - Manipulation 3-4 Regions No 10/10/22 10/10/22 0.00 17.14 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC 09/28/22 98941-AT - Manipulation 3-4 Regions No 10/03/22 10/03/22 0.00 17.14 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 09/21/22 99213-25 - Established Patient Exam - 20-29 Min No 10/03/22 10/03/22 0.00 53.25 0.00 0.00 0.00 53.25 Provider: Dr Brian S Parkhurst DC Patient Totals: 119.98 138.95 0.00 0.00 0.00 258.93 JONME000 Jones, Melissa Group: 00281401 DOB: 06/17/1983 Insured ID: XYH912467556 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 22.99 0.00 0.00 0.00 0.00 22.99 Provider: Dr James Friess DC 10/27/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 22.99 0.00 0.00 0.00 0.00 22.99 Page 16 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 17. Provider: Dr James Friess DC Patient Totals: 45.98 0.00 0.00 0.00 0.00 45.98 MAASA001 Maas, Sandra Group: 00100582 DOB: 11/14/1960 Insured ID: XYS926479782 03/17/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/25/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 03/02/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/07/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 03/14/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Matthew Meiste DC 03/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Matthew Meiste DC 02/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/03/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 03/07/22 97110-GP-97 - Therapy- Therapeutic Exercise No 03/10/22 10/26/22 0.00 0.00 0.00 0.00 26.20 26.20 Provider: Dr Brian S Parkhurst DC 02/21/22 98941-AT - Manipulation 3-4 Regions No 03/03/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 03/02/22 98941-AT - Manipulation 3-4 Regions No 03/07/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 03/14/22 98941-AT - Manipulation 3-4 Regions No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Matthew Meiste DC 03/07/22 98941-AT - Manipulation 3-4 Regions No 03/10/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 03/10/22 98941-AT - Manipulation 3-4 Regions No 03/17/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Matthew Meiste DC 03/17/22 98941-AT - Manipulation 3-4 Regions No 03/25/22 10/26/22 0.00 0.00 0.00 0.00 14.28 14.28 Provider: Dr Brian S Parkhurst DC 02/21/22 99202-25 - New Patient Exam - 15- 29 Min No 03/03/22 10/26/22 0.00 0.00 0.00 0.00 45.42 45.42 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 288.30 288.30 MALJU000 Malone, Julia Group: 00291654 Page 17 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 18. DOB: 03/25/1965 Insured ID: XYW920762794 12/03/21 98941-AT - Manipulation 3-4 Regions No 12/07/21 10/26/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 12/16/21 98941-AT - Manipulation 3-4 Regions No 12/21/21 10/26/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 12/27/21 98941-AT - Manipulation 3-4 Regions No 12/30/21 10/26/22 0.00 0.00 0.00 0.00 34.28 34.28 Provider: Dr Karla A Parkhurst DC 09/23/22 98942-AT - Manipulation 5 Regions No 09/29/22 10/26/22 0.00 20.00 0.00 0.00 0.00 20.00 Provider: Dr Karla A Parkhurst DC 09/19/22 98942-AT - Manipulation 5 Regions No 09/22/22 10/26/22 0.00 20.00 0.00 0.00 0.00 20.00 Provider: Dr Karla A Parkhurst DC 09/16/22 98942-AT - Manipulation 5 Regions No 09/22/22 10/26/22 0.00 20.00 0.00 0.00 0.00 20.00 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 60.00 0.00 0.00 102.84 162.84 ROBMA000 Roberts, Matthew Group: 00111161 DOB: 09/17/1982 Insured ID: XYH917659289 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 23.10 0.00 0.00 0.00 0.00 23.10 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Russell Sweet DC Patient Totals: 57.38 0.00 0.00 0.00 0.00 57.38 SCHJI000 Schutte, Jill Group: 00167361 DOB: 04/13/1990 Insured ID: XYHM07064803 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 34.28 0.00 0.00 0.00 0.00 34.28 Provider: Dr Russell Sweet DC Patient Totals: 34.28 0.00 0.00 0.00 0.00 34.28 SCRMI000 Scripps, Michelle Group: 00285241 DOB: 02/06/1981 Insured ID: XYHM07622539 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr James Friess DC Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 VALLA000 Vall, Laurie, A Group: 00187213 DOB: 09/15/1967 Insured ID: XYH892732269 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Karla A Parkhurst DC Page 18 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 19. Patient Totals: 17.14 0.00 0.00 0.00 0.00 17.14 VANAS000 Vanslooten, Ashley Group: 00285687 DOB: 02/24/1987 Insured ID: XYH925868229 10/17/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 17.14 0.00 0.00 0.00 0.00 17.14 Provider: Dr Karla A Parkhurst DC Patient Totals: 34.28 0.00 0.00 0.00 0.00 34.28 WYSCH000 Wysong, Christopher Group: 00224582 DOB: 07/24/1965 Insured ID: XYH894197710 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 36.78 0.00 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC 10/07/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 0.00 36.78 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 36.78 0.00 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 36.78 0.00 0.00 0.00 0.00 36.78 Provider: Dr James Friess DC Patient Totals: 110.34 36.78 0.00 0.00 0.00 147.12 Carrier Totals: 993.70 491.58 96.71 142.19 517.77 2,241.95 Blue Care Network - Advantage 800-450-3680 HARBR000 Harmon, Bruce Group: 00275566 DOB: 06/10/1956 Insured ID: XYK993609568 10/14/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr James Friess DC Patient Totals: 31.35 0.00 0.00 0.00 0.00 31.35 HARJA001 Harper, James Group: 00275566 DOB: 03/17/1949 Insured ID: XYK891592068 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 19.10 0.00 0.00 0.00 0.00 19.10 Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.10 0.00 0.00 0.00 0.00 19.10 HERAM000 Herrera, Amparo Group: 00275566 DOB: 05/26/1942 Insured ID: XYK992254343 09/15/22 98941-AT - Manipulation 3-4 Regions No 09/22/22 09/22/22 0.00 19.71 0.00 0.00 0.00 19.71 Provider: Dr Karla A Parkhurst DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr Karla A Parkhurst DC Patient Totals: 19.71 19.71 0.00 0.00 0.00 39.42 KRANA000 Kraak, Nancy, L Group: 00275566 DOB: 06/11/1949 Insured ID: XYK992287055 10/28/22 98941-AT - No 11/03/22 11/03/22 19.10 0.00 0.00 0.00 0.00 19.10 Page 19 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 20. Manipulation 3-4 Regions Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.10 0.00 0.00 0.00 0.00 19.10 MARCO000 Marques, Cora Group: 00275566 DOB: 10/07/1945 Insured ID: XYK894277254 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.71 0.00 0.00 0.00 0.00 19.71 MCGLE000 McGowan, Leslie, H Group: 00275566 DOB: 05/09/1955 Insured ID: XYK993521282 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr James Friess DC Patient Totals: 19.71 0.00 0.00 0.00 0.00 19.71 SHAHO000 Shank, Holly Group: 00275566 DOB: 12/26/1949 Insured ID: XYK918807751 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr James Friess DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr James Friess DC Patient Totals: 39.42 0.00 0.00 0.00 0.00 39.42 TAYCH000 Taylor, Christine, C Group: 00275566 DOB: 03/25/1957 Insured ID: XYK993577545 10/13/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 19.71 0.00 0.00 0.00 0.00 19.71 Provider: Dr Karla A Parkhurst DC Patient Totals: 19.71 0.00 0.00 0.00 0.00 19.71 VANJI000 VanDam, Jill Group: 00275566 DOB: 05/04/1951 Insured ID: XYK992898693 10/31/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Samantha J Spooner DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/07/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/10/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 09/29/22 98942-AT - Manipulation 5 Regions No 10/05/22 10/05/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC Page 20 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 21. 09/26/22 98942-AT - Manipulation 5 Regions No 09/29/22 09/29/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/13/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 31.35 0.00 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC 09/22/22 98942-AT - Manipulation 5 Regions No 09/29/22 09/29/22 0.00 31.35 0.00 0.00 0.00 31.35 Provider: Dr Brian S Parkhurst DC Patient Totals: 188.10 125.40 0.00 0.00 0.00 313.50 WISSA000 Wissink, Sally Group: 00275566 DOB: 04/12/1959 Insured ID: XYK911992677 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 19.55 0.00 0.00 0.00 0.00 19.55 Provider: Dr Jeremy Lengkeek DC Patient Totals: 19.55 0.00 0.00 0.00 0.00 19.55 Carrier Totals: 395.46 145.11 0.00 0.00 0.00 540.57 Blue Cross Blue Shield BEHJE000 Behrendt, Jeanine Group: 71453 DOB: 06/30/1969 Insured ID: MMJ892419700 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Karla A Parkhurst DC Patient Totals: 130.26 0.00 0.00 0.00 0.00 130.26 BOWCA000 Bowen, Cara Group: 71453 DOB: 05/02/1986 Insured ID: MMJ911741218 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/21/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 BURHE000 Burleson, Heather Group: 71452 DOB: 01/18/1986 Insured ID: MMJ916375238 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 CHAAL000 Chatten, Alison Group: 71453 DOB: 05/12/1992 Insured ID: MMJ923197183 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Karla A Parkhurst DC Page 21 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 22. 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Karla A Parkhurst DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 DYKCL000 Dykhouse, Clayton Group: 71453 DOB: 03/06/2001 Insured ID: MMJ892728153 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 FENMI001 Fenlon, Mirra Group: 71453 DOB: 10/10/2007 Insured ID: MMJ890750273 12/17/21 98941-AT - Manipulation 3-4 Regions No 12/21/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Brian S Parkhurst DC 12/20/21 98941-AT - Manipulation 3-4 Regions No 12/24/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Brian S Parkhurst DC 12/13/21 98941-AT - Manipulation 3-4 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Brian S Parkhurst DC 12/10/21 98941-AT - Manipulation 3-4 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 41.50 41.50 Provider: Dr Russell Sweet DC Patient Totals: 0.00 0.00 0.00 0.00 166.00 166.00 GRADA000 Grassmid, Danielle Group: 71453 DOB: 09/22/1987 Insured ID: MMJ913317894 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 09/28/22 97012-GP - Therapy- Traction/Mechanical No 10/03/22 10/03/22 0.00 16.06 0.00 0.00 0.00 16.06 Provider: Dr James Friess DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr James Friess DC 09/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/03/22 10/03/22 0.00 66.50 0.00 0.00 0.00 66.50 Provider: Dr James Friess DC 06/08/22 98942-AT - Manipulation 5 Regions No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 56.97 56.97 Provider: Dr James Friess DC 06/08/22 97012-GP - Therapy- Traction/Mechanical No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 16.12 16.12 Provider: Dr James Friess DC Page 22 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 23. 06/08/22 97124-59-GP - Therapeutic Massage w/AIS No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 49.50 49.50 Provider: Dr James Friess DC 06/16/22 97124-59-GP - Therapeutic Massage w/AIS No 06/23/22 10/05/22 0.00 0.00 0.00 0.00 49.50 49.50 Provider: Dr James Friess DC 06/16/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/23/22 10/05/22 0.00 0.00 0.00 0.00 32.60 32.60 Provider: Dr James Friess DC 06/08/22 97110-GP-97 - Therapy- Therapeutic Exercise No 06/13/22 10/05/22 0.00 0.00 0.00 0.00 32.60 32.60 Provider: Dr James Friess DC Patient Totals: 130.26 82.56 0.00 0.00 237.29 450.11 GRARO001 Grassmid, Robert Group: 71453 DOB: 04/23/2022 Insured ID: MMJ913317894 07/27/22 99202-25 - New Patient Exam - 15- 29 Min No 08/01/22 10/05/22 0.00 0.00 0.00 89.83 0.00 89.83 Provider: Dr James Friess DC 07/27/22 98940-AT - Manipulation 1-2 Regions No 08/01/22 10/05/22 0.00 0.00 0.00 30.97 0.00 30.97 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 120.80 0.00 120.80 GREKA000 Greene, Kathryn Group: 71565 DOB: 03/27/1978 Insured ID: WYOM09024247 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 14.76 0.00 0.00 0.00 0.00 14.76 Provider: Dr James Friess DC 10/20/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 66.51 0.00 0.00 0.00 0.00 66.51 HESCH000 Hester, Charles, O Group: 072378 DOB: 12/20/1965 Insured ID: RYD834549262 01/17/22 98942-AT - Manipulation 5 Regions No 01/20/22 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr James Friess DC 12/15/21 98941-AT - Manipulation 3-4 Regions No 12/21/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/13/21 98941-AT - Manipulation 3-4 Regions No 12/17/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/01/21 98941-AT - Manipulation 3-4 Regions No 12/07/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/09/21 98941-AT - Manipulation 3-4 Regions No 12/14/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Page 23 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 24. Provider: Dr Matthew Meiste DC 12/07/21 98941-AT - Manipulation 3-4 Regions No 12/10/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 12/03/21 98941-AT - Manipulation 3-4 Regions No 12/07/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Russell Sweet DC 12/20/21 98941-AT - Manipulation 3-4 Regions No 12/24/21 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 01/03/22 98941-AT - Manipulation 3-4 Regions No 01/07/22 10/20/22 0.00 0.00 0.00 0.00 20.00 20.00 Provider: Dr Matthew Meiste DC 11/23/21 99202-25 - New Patient Exam - 15- 29 Min No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Matthew Meiste DC 11/23/21 72040 - X-ray Cervical Spine - 2-3 Views No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 62.85 62.85 Provider: Dr Matthew Meiste DC 11/23/21 72070 - X-ray Thoracic Spine - 2-3 Views No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 51.92 51.92 Provider: Dr Matthew Meiste DC 11/23/21 72100 - X-ray Lumbosacral 2-3 Views No 12/06/21 10/20/22 0.00 0.00 0.00 0.00 63.40 63.40 Provider: Dr Matthew Meiste DC Patient Totals: 0.00 0.00 0.00 0.00 383.17 383.17 HOETO000 Hoeker, Tobi Group: 71453 DOB: 01/29/1979 Insured ID: MMJ892425427 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 HOLCO000 Holtrust, Conner Group: 71565 DOB: 06/17/2001 Insured ID: WYO891403313 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Karla A Parkhurst DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 JANMA000 Janicik, Marissa Group: 71453 DOB: 10/15/1983 Insured ID: MMJ917944880 Page 24 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 25. 10/28/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Russell Sweet DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Russell Sweet DC Patient Totals: 294.10 0.00 0.00 0.00 0.00 294.10 JOHDA000 Johnston, David Group: 71453 DOB: 08/10/1969 Insured ID: MMJ893146867 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Brian S Parkhurst DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 JONLE000 Jones, Lee Ann Group: 71452 DOB: 02/14/1965 Insured ID: MMJ891828325 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 KREKR000 Krefeld Freier, Krista Group: 71565 DOB: 08/19/1969 Insured ID: WYO893053461 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC 10/27/22 97110-GP-97 - Therapy- Therapeutic No 11/03/22 11/03/22 14.76 0.00 0.00 0.00 0.00 14.76 Page 25 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 26. Exercise Provider: Dr Karla A Parkhurst DC 10/27/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Karla A Parkhurst DC Patient Totals: 92.87 0.00 0.00 0.00 0.00 92.87 KROBR000 Kropscott, Brysen, R Group: 71453 DOB: 09/10/2014 Insured ID: MMJ911630343 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC Patient Totals: 92.72 0.00 0.00 0.00 0.00 92.72 KRODA001 Kropscott, David Group: 71453 DOB: 05/08/1983 Insured ID: MMJ911630343 10/31/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr James Friess DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr James Friess DC 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC Patient Totals: 294.10 0.00 0.00 0.00 0.00 294.10 KROHE000 Kropscott, Heather Group: 71453 DOB: 03/01/1983 Insured ID: MMJ911630343 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/27/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 121.48 0.00 0.00 0.00 0.00 121.48 LACCH000 Lacny, Charles Group: 71453 DOB: 09/01/2005 Insured ID: MMJ891213482 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Page 26 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 27. Provider: Dr Jeremy Lengkeek DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 LECCH000 Leclair, Christopher Group: 71453 DOB: 12/20/1983 Insured ID: MMJ917212174 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Brian S Parkhurst DC 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Brian S Parkhurst DC Patient Totals: 149.66 0.00 0.00 0.00 0.00 149.66 STACO000 Leeuwenburg, Courtney Group: 71453 DOB: 10/20/1989 Insured ID: MMJ922520202 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 97124-59-GP - Therapeutic Massage w/AIS No 10/31/22 10/31/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 149.66 0.00 0.00 0.00 0.00 149.66 MAITI000 Maillet, Timothy Group: 049218 DOB: 03/28/1983 Insured ID: YAQ869210946M 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 32.45 0.00 0.00 0.00 0.00 32.45 Provider: Dr Jeremy Lengkeek DC Patient Totals: 32.45 0.00 0.00 0.00 0.00 32.45 MELCH000 Melvin , Christine Group: 71453 DOB: 09/03/1997 Insured ID: MMJ923085425 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC 10/17/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC Page 27 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 28. 10/10/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/12/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/14/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/12/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/10/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/27/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/14/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/27/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/10/22 72040 - X-ray Cervical Spine - 2-3 Views No 10/24/22 10/24/22 70.63 0.00 0.00 0.00 0.00 70.63 Provider: Dr James Friess DC 10/10/22 72070 - X-ray Thoracic Spine - 2-3 Views No 10/24/22 10/24/22 58.67 0.00 0.00 0.00 0.00 58.67 Provider: Dr James Friess DC 10/10/22 72100 - X-ray Lumbosacral 2-3 Views No 10/24/22 10/24/22 71.23 0.00 0.00 0.00 0.00 71.23 Provider: Dr James Friess DC 10/10/22 99203-25 - New Patient Exam - 30- 44 Min No 10/24/22 10/24/22 132.96 0.00 0.00 0.00 0.00 132.96 Provider: Dr James Friess DC 10/27/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 856.42 0.00 0.00 0.00 0.00 856.42 MULHE000 Mulder, Heather Group: 71565 DOB: 12/09/1965 Insured ID: WYO890772291 Page 28 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 29. 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 54.67 0.00 0.00 0.00 0.00 54.67 Provider: Dr James Friess DC Patient Totals: 54.67 0.00 0.00 0.00 0.00 54.67 MULPA000 Mulder, Paul Group: 71565 DOB: 03/10/1966 Insured ID: WYO890772291 10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 15.11 0.00 0.00 0.00 0.00 15.11 Provider: Dr James Friess DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 41.72 0.00 0.00 0.00 0.00 41.72 Provider: Dr James Friess DC Patient Totals: 56.83 0.00 0.00 0.00 0.00 56.83 MUMGA000 Mummert, Gabrielle Group: 000071565 DOB: 03/06/1997 Insured ID: WYO922692008 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC 10/12/22 98941-AT - Manipulation 3-4 Regions No 10/17/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC 10/05/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/10/22 10/20/22 0.00 69.52 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/12/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/17/22 10/20/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC Patient Totals: 301.28 69.52 0.00 0.00 0.00 370.80 NGUTA000 Nguyen, Tammy Group: 71452 DOB: 08/31/1972 Insured ID: MMJ890049963 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/19/22 97124-59-GP - Therapeutic Massage w/AIS No 10/24/22 10/24/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 Page 29 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 30. PATJU000 Paterick, Julie Group: 71453 DOB: 06/17/1975 Insured ID: MMJ891962454 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/20/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 PERDI000 Perez, Diane Group: 74153 DOB: 06/09/1963 Insured ID: MMJ890306138 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/09/22 11/09/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 PRIBR000 Prieditis, Bradley Group: 71453 DOB: 08/24/1972 Insured ID: MMJ894544304 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Russell Sweet DC Patient Totals: 132.67 0.00 0.00 0.00 0.00 132.67 STOMA000 Stout, Matthew Group: 71453 DOB: 05/28/1988 Insured ID: MMJ922632308 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/24/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 STOMI000 Stout, Micah Group: 71453 DOB: 11/24/2021 Insured ID: MMJ922632308 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 Page 30 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 31. TAYJE000 Taylor, Jennifer Group: 71453 DOB: 01/10/1972 Insured ID: MMJ894410152 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/28/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 TAYMA000 Taylor, Margaret Group: 71453 DOB: 09/21/2007 Insured ID: MMJ894410152 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/18/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 VANSU003 Vanderbilt, Susan Group: 71453 DOB: 11/23/1969 Insured ID: MMJ892603982 10/21/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/25/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Russell Sweet DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/25/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/19/22 72070 - X-ray Thoracic Spine - 2-3 Views No 10/24/22 10/24/22 58.67 0.00 0.00 0.00 0.00 58.67 Provider: Dr Russell Sweet DC 10/19/22 72100 - X-ray No 10/24/22 10/24/22 71.23 0.00 0.00 0.00 0.00 71.23 Page 31 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 32. Lumbosacral 2-3 Views Provider: Dr Russell Sweet DC 10/19/22 99203-25 - New Patient Exam - 30- 44 Min No 10/24/22 10/24/22 132.96 0.00 0.00 0.00 0.00 132.96 Provider: Dr Russell Sweet DC 10/21/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 34.50 0.00 0.00 0.00 0.00 34.50 Provider: Dr Russell Sweet DC 10/19/22 72040 - X-ray Cervical Spine - 2-3 Views No 10/24/22 10/24/22 70.63 0.00 0.00 0.00 0.00 70.63 Provider: Dr Russell Sweet DC Patient Totals: 635.34 0.00 0.00 0.00 0.00 635.34 VANDO002 Vanderhulst, Dominic Group: 71453 DOB: 06/13/2007 Insured ID: MMJ891517239 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 VANKA004 Vanderhulst, Kaylie Group: 71453 DOB: 12/28/2004 Insured ID: MMJ891517239 10/31/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 VANAM003 Vandermeulen, Amanda Group: 71565 DOB: 08/12/1976 Insured ID: WYO894190112 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 60.74 0.00 0.00 0.00 0.00 60.74 VANBR003 Vandermeulen, Breslyn Group: 71565 DOB: 07/08/2013 Insured ID: WYO894190112 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 VANBR002 Vandermeulen, Brynlee Group: 71565 DOB: 03/23/2010 Insured ID: WYO894190112 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Brian S Parkhurst DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 VANCA000 Vanfaasen, Carl Group: 71453 DOB: 02/25/1970 Insured ID: MMJ892007429 Page 32 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 33. 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/19/22 97124-59-GP - Therapeutic Massage w/AIS No 10/24/22 10/24/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 164.04 0.00 0.00 0.00 0.00 164.04 VANPA000 Vanfaasen, Pamela Group: 71453 DOB: 11/27/1973 Insured ID: MMJ892007429 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/28/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 MULKR000 VanKoevering, Kristen Group: 51565 DOB: 06/20/1997 Insured ID: WYO890772291 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 54.67 0.00 0.00 0.00 0.00 54.67 Provider: Dr James Friess DC Patient Totals: 54.67 0.00 0.00 0.00 0.00 54.67 VOSBR000 Voss, Bryan Group: DOB: 08/24/1970 Insured ID: MMJ891872817 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Jeremy Lengkeek DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC 10/24/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Jeremy Lengkeek DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 VOSJE000 Voss, Jenanne Group: 71453 DOB: 09/20/1970 Insured ID: MMJ891872817 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Karla A Parkhurst DC Page 33 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 34. 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/28/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Karla A Parkhurst DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 VRIDE000 Vriesman, Deirdre Group: 71453 DOB: 02/19/1979 Insured ID: MMJ890604289 10/21/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/21/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Russell Sweet DC Patient Totals: 147.25 0.00 0.00 0.00 0.00 147.25 WELAN000 Welsh-Lloyd, Angela Group: 71453 DOB: 05/21/1975 Insured ID: MMJ891979060 12/22/21 97124-59-GP - Therapeutic Massage w/AIS No 12/30/21 10/26/22 0.00 0.00 0.00 0.00 47.25 47.25 Provider: Dr James Friess DC 12/22/21 97110-GP-97 - Therapy- Therapeutic Exercise No 12/30/21 10/26/22 0.00 0.00 0.00 0.00 31.12 31.12 Provider: Dr James Friess DC Patient Totals: 0.00 0.00 0.00 0.00 78.37 78.37 WHIKA001 Whitmyer, Kati Group: 71453 DOB: 07/16/1978 Insured ID: MMJ892557352 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC 10/24/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr Karla A Parkhurst DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC Patient Totals: 132.87 0.00 0.00 0.00 0.00 132.87 WHINA000 Whitmyer, Nathan Group: 71453 DOB: 12/24/1977 Insured ID: MMJ892557352 10/20/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Page 34 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 35. Provider: Dr James Friess DC Patient Totals: 77.53 0.00 0.00 0.00 0.00 77.53 WURBE000 Wurst, Beth Group: 71453 DOB: 09/03/1972 Insured ID: MMJ894072454 10/27/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/21/22 97124-59-GP - Therapeutic Massage w/AIS No 10/26/22 10/26/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC 10/27/22 97124-59-GP - Therapeutic Massage w/AIS No 11/03/22 11/03/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC 10/31/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC Patient Totals: 233.76 0.00 0.00 0.00 0.00 233.76 Carrier Totals: 6,570.75 152.08 0.00 120.80 864.83 7,708.46 Blue Cross Blue Shield ARNLA000 Arnett, Laura Group: 020422 DOB: 10/12/1965 Insured ID: CUY000495330 10/11/22 98941-AT - Manipulation 3-4 Regions No 10/17/22 10/17/22 31.36 0.00 0.00 0.00 0.00 31.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 31.36 0.00 0.00 0.00 0.00 31.36 BELTE000 Bellingar, Teresa, A Group: DOB: 06/14/1964 Insured ID: HAW920519136 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 30.74 0.00 0.00 0.00 0.00 30.74 Provider: Dr James Friess DC Patient Totals: 30.74 0.00 0.00 0.00 0.00 30.74 BENGA001 Benavidez, Gabriel Group: 007000562 DOB: 11/13/1977 Insured ID: MIG914411035 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/25/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC Page 35 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 36. 10/21/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/26/22 10/26/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/21/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC Patient Totals: 222.99 0.00 0.00 0.00 0.00 222.99 BENNO000 Benavidez, Nora Group: 007000562 DOB: 09/15/1982 Insured ID: MIG914411035 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 09/30/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/18/22 11/03/22 0.00 34.76 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/31/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/21/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 09/30/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/18/22 11/03/22 0.00 17.18 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/31/22 97032-GP-59-97 - Therapy - E-Stim Attended No 11/03/22 11/03/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/31/22 10/31/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC 10/21/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 63.94 0.00 0.00 0.00 0.00 63.94 Provider: Dr Russell Sweet DC 09/30/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/18/22 11/03/22 0.00 31.97 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC 10/31/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC Patient Totals: 295.70 83.91 0.00 0.00 0.00 379.61 Page 36 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 37. BERRA000 Bergman, Rachelle Group: DOB: 10/20/1977 Insured ID: KQD3HZN14745300 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Karla A Parkhurst DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 BLYSA001 Blystra, Sara Group: 5803289-DC10 DOB: 02/17/1976 Insured ID: WGJ837762312 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 BOEBE000 Boetsma, Berrett Group: 5803289-DC10 DOB: 05/29/2009 Insured ID: WGJ835801799 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 92.72 0.00 0.00 0.00 0.00 92.72 BOEBR000 Boetsma, Brylee Group: 5803289-DC10 DOB: 09/22/2005 Insured ID: WGJ835801799 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC Patient Totals: 185.44 0.00 0.00 0.00 0.00 185.44 BOEJU000 Boetsma, Julie Group: 5803289-DC10 DOB: 11/02/1980 Insured ID: WGJ835801799 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Russell Sweet DC Patient Totals: 6.36 0.00 0.00 0.00 0.00 6.36 BOEMO000 Boeve, Monica Group: 71565 DOB: 12/06/1981 Insured ID: WYO911217444 10/24/22 98942-AT - Manipulation 5 Regions No 10/26/22 10/26/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC Page 37 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 38. 10/24/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 63.94 0.00 0.00 0.00 0.00 63.94 Provider: Dr James Friess DC Patient Totals: 159.44 0.00 0.00 0.00 0.00 159.44 BORKI000 Borri, Kimberly Group: W0088557 DOB: 08/06/1967 Insured ID: XEA910465013 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 21.36 0.00 0.00 0.00 0.00 21.36 Provider: Dr Karla A Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/26/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/31/22 10/31/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Karla A Parkhurst DC 10/26/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/31/22 10/31/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Karla A Parkhurst DC Patient Totals: 105.27 0.00 0.00 0.00 0.00 105.27 BORSA000 Borri, Samuel Group: W0088557 DOB: 07/14/1999 Insured ID: XEA910465013 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Jeremy Lengkeek DC 10/24/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Jeremy Lengkeek DC 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 21.36 0.00 0.00 0.00 0.00 21.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 110.40 0.00 0.00 0.00 0.00 110.40 BRABR000 Bradshaw, Britney Group: 201060M1A1 DOB: 06/11/1986 Insured ID: XRQ819W09165 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Karla A Parkhurst DC Patient Totals: 46.36 0.00 0.00 0.00 0.00 46.36 BROME000 Brown, Melissa, J Group: 71565 DOB: 06/01/1968 Insured ID: WYO892628550 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 COMPA000 Compagner, Paula Group: 074224 DOB: 03/17/1968 Insured ID: YFE826441505 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Page 38 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 39. Provider: Dr Karla A Parkhurst DC 10/19/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/24/22 10/24/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Karla A Parkhurst DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/19/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/24/22 10/24/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Karla A Parkhurst DC Patient Totals: 130.27 0.00 0.00 0.00 0.00 130.27 CONLI000 Conti, Lisa Group: 10567865 DOB: 12/22/1966 Insured ID: H6U104151946001 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Karla A Parkhurst DC 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Karla A Parkhurst DC 10/26/22 97012-GP - Therapy- Traction/Mechanical No 10/31/22 10/31/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Karla A Parkhurst DC Patient Totals: 92.67 0.00 0.00 0.00 0.00 92.67 COOLA000 Cook, Laura Group: 007017055 DOB: 12/19/1975 Insured ID: XYQ920739457 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/09/22 11/09/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 COYSU000 Coy, Susan Group: 007000562 DOB: 10/09/1973 Insured ID: MIG890788924 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Karla A Parkhurst DC 10/28/22 97032-GP-59-97 - Therapy - E-Stim Attended No 11/03/22 11/03/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Karla A Parkhurst DC 10/28/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/03/22 11/03/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Karla A Parkhurst DC 10/28/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 11/03/22 11/03/22 43.94 0.00 0.00 0.00 0.00 43.94 Provider: Dr Karla A Parkhurst DC Page 39 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 40. Patient Totals: 148.60 0.00 0.00 0.00 0.00 148.60 DALTO000 Dalman, Todd Group: 71350 DOB: 11/24/1968 Insured ID: RGI893455836 11/01/22 98941-AT - Manipulation 3-4 Regions No 11/09/22 11/09/22 21.36 0.00 0.00 0.00 0.00 21.36 Provider: Dr Jeremy Lengkeek DC 10/18/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 44.52 0.00 0.00 0.00 0.00 44.52 Provider: Dr Jeremy Lengkeek DC 11/01/22 97110-GP-97 - Therapy- Therapeutic Exercise No 11/09/22 11/09/22 69.52 0.00 0.00 0.00 0.00 69.52 Provider: Dr Jeremy Lengkeek DC Patient Totals: 135.40 0.00 0.00 0.00 0.00 135.40 DAMCA000 Dampier, Caitlin Group: 71553 DOB: 03/18/1990 Insured ID: haw922576200 10/26/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/31/22 10/31/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Russell Sweet DC 10/26/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/31/22 10/31/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Russell Sweet DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Russell Sweet DC 10/26/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/31/22 10/31/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Russell Sweet DC Patient Totals: 269.35 0.00 0.00 0.00 0.00 269.35 DAMMI000 Dampier, Michael Group: 000071553 DOB: 07/12/1985 Insured ID: HAW922576200 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Russell Sweet DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 16.36 0.00 0.00 0.00 0.00 16.36 Provider: Dr Russell Sweet DC 10/21/22 98941-AT - Manipulation 3-4 No 10/26/22 10/26/22 16.36 0.00 0.00 0.00 0.00 16.36 Page 40 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 41. Regions Provider: Dr Russell Sweet DC Patient Totals: 49.08 0.00 0.00 0.00 0.00 49.08 DELTR000 Dellavecchia, Tracey Group: 007004452 DOB: 12/28/1976 Insured ID: MJU916962311 04/22/22 98941-AT - Manipulation 3-4 Regions No 04/28/22 10/05/22 0.00 0.00 0.00 0.00 50.00 50.00 Provider: Dr Karla A Parkhurst DC 04/22/22 97012-GP - Therapy- Traction/Mechanical No 04/28/22 10/05/22 0.00 0.00 0.00 0.00 24.00 24.00 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 0.00 0.00 0.00 74.00 74.00 DEMMI000 Demott, Michelle Group: 270130MPD1 DOB: 04/06/1983 Insured ID: HFY972W07102 10/19/22 98942-AT - Manipulation 5 Regions No 10/24/22 10/24/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/26/22 98942-AT - Manipulation 5 Regions No 10/31/22 10/31/22 60.74 0.00 0.00 0.00 0.00 60.74 Provider: Dr James Friess DC 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC Patient Totals: 167.84 0.00 0.00 0.00 0.00 167.84 DEVGA000 DeVries, Gail Group: JWI003 DOB: 12/17/1965 Insured ID: LBN1229966MB 10/07/22 98942-AT - Manipulation 5 Regions No 10/13/22 10/13/22 0.00 40.74 0.00 0.00 0.00 40.74 Provider: Dr James Friess DC 10/17/22 98942-AT - Manipulation 5 Regions No 10/20/22 10/20/22 40.74 0.00 0.00 0.00 0.00 40.74 Provider: Dr Russell Sweet DC 10/28/22 98942-AT - Manipulation 5 Regions No 11/03/22 11/03/22 40.74 0.00 0.00 0.00 0.00 40.74 Provider: Dr Russell Sweet DC Patient Totals: 81.48 40.74 0.00 0.00 0.00 122.22 DEVMI000 DeVries, Michael Group: 71792 DOB: 05/22/1996 Insured ID: SEE923300334 10/10/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/13/22 10/13/22 49.52 0.00 0.00 0.00 0.00 49.52 Provider: Dr James Friess DC Patient Totals: 49.52 0.00 0.00 0.00 0.00 49.52 DEWDA001 Dewaard, Damien Group: 71557 DOB: 07/30/2000 Insured ID: OLZ922650313 10/27/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr James Friess DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr James Friess DC Page 41 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 42. 10/20/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 13.43 0.00 0.00 0.00 0.00 13.43 Provider: Dr James Friess DC 10/27/22 97012-GP - Therapy- Traction/Mechanical No 11/03/22 11/03/22 13.43 0.00 0.00 0.00 0.00 13.43 Provider: Dr James Friess DC Patient Totals: 101.04 0.00 0.00 0.00 0.00 101.04 DORPA000 Dorn, Paul Group: 007013084 DOB: 12/07/1973 Insured ID: XYQM61881196 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Jeremy Lengkeek DC 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 12.72 0.00 0.00 0.00 0.00 12.72 EAKKE000 Eakley, Kennedi Group: 71549 DOB: 04/24/2001 Insured ID: KMT892581274 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Jeremy Lengkeek DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 EAKTH000 Eakley, Thomas Group: 71549 DOB: 10/04/1968 Insured ID: KMT892581274 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Jeremy Lengkeek DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 ERSER000 Ersfeld, Ernest Group: 00935000070 DOB: 03/20/1943 Insured ID: NJX3HZN10213510 07/08/22 98942-AT - Manipulation 5 Regions No 07/13/22 10/05/22 0.00 0.00 0.00 0.00 10.18 10.18 Provider: Dr Brian S Parkhurst DC 08/08/22 98942-AT - Manipulation 5 Regions No 08/11/22 10/05/22 0.00 0.00 0.00 10.18 0.00 10.18 Provider: Dr James Friess DC 08/19/22 98942-AT - Manipulation 5 Regions No 08/25/22 09/26/22 0.00 0.00 10.18 0.00 0.00 10.18 Provider: Dr Brian S Parkhurst DC Patient Totals: 0.00 0.00 10.18 10.18 10.18 30.54 ERSPA000 Ersfeld, Pamela Group: 00935000070 DOB: 02/22/1944 Insured ID: NJX3HZN99578530 09/19/22 98941-AT - Manipulation 3-4 Regions No 09/22/22 10/13/22 0.00 7.76 0.00 0.00 0.00 7.76 Provider: Dr Karla A Parkhurst DC 08/29/22 98941-AT - Manipulation 3-4 Regions No 09/01/22 09/29/22 0.00 0.00 7.76 0.00 0.00 7.76 Provider: Dr Karla A Parkhurst DC 06/20/22 98941-AT - Manipulation 3-4 Regions No 06/23/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Page 42 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 43. Provider: Dr Karla A Parkhurst DC 06/27/22 98941-AT - Manipulation 3-4 Regions No 06/30/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 06/03/22 98941-AT - Manipulation 3-4 Regions No 06/09/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 05/26/22 98941-AT - Manipulation 3-4 Regions No 06/02/22 10/24/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 06/09/22 98941-AT - Manipulation 3-4 Regions No 06/16/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC 06/13/22 98941-AT - Manipulation 3-4 Regions No 06/16/22 10/05/22 0.00 0.00 0.00 0.00 7.76 7.76 Provider: Dr Karla A Parkhurst DC Patient Totals: 0.00 7.76 7.76 0.00 46.56 62.08 ESPPA000 Espinoza, Paul Group: 007047642 DOB: 11/26/1965 Insured ID: LFIM04107707 10/31/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr James Friess DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 FEGST000 Fegel, Stephanie Group: 007013084 DOB: 10/08/1987 Insured ID: XYQ914895601 10/20/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/26/22 10/26/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr Jeremy Lengkeek DC 10/20/22 97032-GP-59-97 - Therapy - E-Stim Attended No 10/26/22 10/26/22 17.18 0.00 0.00 0.00 0.00 17.18 Provider: Dr Jeremy Lengkeek DC 10/20/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr Jeremy Lengkeek DC 10/20/22 97140-GP-59-97 - Therapy-Manual (Trigger Point, Myofascial Release) No 10/26/22 10/26/22 31.97 0.00 0.00 0.00 0.00 31.97 Provider: Dr Jeremy Lengkeek DC Patient Totals: 130.27 0.00 0.00 0.00 0.00 130.27 FRAJA001 Frazier, Ja-mariah Group: 71440 DOB: 08/22/2005 Insured ID: NHT922166138 10/24/22 98941-AT - Manipulation 3-4 Regions No 10/26/22 10/26/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Brian S Parkhurst DC 10/19/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 6.36 0.00 0.00 0.00 0.00 6.36 Provider: Dr Brian S Parkhurst DC 10/24/22 97110-GP-97 - Therapy- Therapeutic No 10/26/22 10/26/22 29.52 0.00 0.00 0.00 0.00 29.52 Page 43 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 44. Exercise Provider: Dr Brian S Parkhurst DC 10/19/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 29.52 0.00 0.00 0.00 0.00 29.52 Provider: Dr Brian S Parkhurst DC 10/19/22 97012-GP - Therapy- Traction/Mechanical No 10/24/22 10/24/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC 10/24/22 97012-GP - Therapy- Traction/Mechanical No 10/26/22 10/26/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr Brian S Parkhurst DC Patient Totals: 105.34 0.00 0.00 0.00 0.00 105.34 GEMRE000 Gemmill, Rene Group: 71549 DOB: 02/02/1971 Insured ID: KMT891844716 10/26/22 98941-AT - Manipulation 3-4 Regions No 10/31/22 10/31/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr Russell Sweet DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 GEURY000 Geurink, Ryan Group: 270130MPD1 DOB: 08/03/1991 Insured ID: HFY857W07102 10/18/22 97110-GP-97 - Therapy- Therapeutic Exercise No 10/24/22 10/24/22 34.76 0.00 0.00 0.00 0.00 34.76 Provider: Dr James Friess DC 10/18/22 97124-59-GP - Therapeutic Massage w/AIS No 10/24/22 10/24/22 51.75 0.00 0.00 0.00 0.00 51.75 Provider: Dr James Friess DC Patient Totals: 86.51 0.00 0.00 0.00 0.00 86.51 GIBJO000 Gibson, Joanne Group: 174208M8AE DOB: 09/17/1958 Insured ID: VWW318M87256 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 41.72 0.00 0.00 0.00 0.00 41.72 Provider: Dr Jeremy Lengkeek DC 10/18/22 98941-AT - Manipulation 3-4 Regions No 10/24/22 10/24/22 41.72 0.00 0.00 0.00 0.00 41.72 Provider: Dr Jeremy Lengkeek DC Patient Totals: 83.44 0.00 0.00 0.00 0.00 83.44 GIBME000 Gibson, Melissa, J Group: 71372 DOB: 04/14/1986 Insured ID: MZO910970356 06/16/22 98941-AT - Manipulation 3-4 Regions No 06/23/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 06/15/22 98941-AT - Manipulation 3-4 Regions No 06/23/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 08/18/22 98941-AT - Manipulation 3-4 Regions No 08/25/22 09/12/22 0.00 0.00 25.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 08/05/22 98941-AT - Manipulation 3-4 Regions No 08/11/22 09/29/22 0.00 0.00 0.00 25.00 0.00 25.00 Page 44 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656
  • 45. Provider: Dr Karla A Parkhurst DC 07/22/22 98941-AT - Manipulation 3-4 Regions No 07/28/22 09/29/22 0.00 0.00 0.00 25.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 06/27/22 98941-AT - Manipulation 3-4 Regions No 06/30/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 06/22/22 98941-AT - Manipulation 3-4 Regions No 06/28/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 07/08/22 98941-AT - Manipulation 3-4 Regions No 07/13/22 09/29/22 0.00 0.00 0.00 0.00 25.00 25.00 Provider: Dr Karla A Parkhurst DC 08/31/22 98941-AT - Manipulation 3-4 Regions No 09/07/22 09/26/22 0.00 0.00 25.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 09/14/22 98941-AT - Manipulation 3-4 Regions No 09/14/22 09/29/22 0.00 25.00 0.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 09/29/22 98941-AT - Manipulation 3-4 Regions No 10/05/22 10/24/22 0.00 25.00 0.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 10/10/22 98941-AT - Manipulation 3-4 Regions No 10/13/22 10/31/22 25.00 0.00 0.00 0.00 0.00 25.00 Provider: Dr Karla A Parkhurst DC 06/15/22 99203-25 - New Patient Exam - 30- 44 Min No 06/23/22 09/29/22 0.00 0.00 0.00 0.00 63.84 63.84 Provider: Dr Karla A Parkhurst DC Patient Totals: 25.00 50.00 50.00 50.00 188.84 363.84 GOEAU001 Goerner, Aubrey Group: 197162 DOB: 12/02/1998 Insured ID: HJD829647380 10/28/22 98941-AT - Manipulation 3-4 Regions No 11/03/22 11/03/22 26.36 0.00 0.00 0.00 0.00 26.36 Provider: Dr Jeremy Lengkeek DC Patient Totals: 26.36 0.00 0.00 0.00 0.00 26.36 GRAJE000 Gradler, Jessica Group: 213019M113 DOB: 03/29/2002 Insured ID: KEF160A24915 10/14/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 37.09 0.00 0.00 0.00 0.00 37.09 Provider: Dr James Friess DC Patient Totals: 37.09 0.00 0.00 0.00 0.00 37.09 GRARO000 Gradler, Roger Group: 213019M113 DOB: 09/11/2000 Insured ID: KEF160A24915 10/13/22 97012-GP - Therapy- Traction/Mechanical No 10/20/22 10/20/22 16.79 0.00 0.00 0.00 0.00 16.79 Provider: Dr James Friess DC 10/13/22 98941-AT - Manipulation 3-4 Regions No 10/20/22 10/20/22 46.36 0.00 0.00 0.00 0.00 46.36 Provider: Dr James Friess DC Patient Totals: 63.15 0.00 0.00 0.00 0.00 63.15 Page 45 Parkhurst Chiropractic Life Center PLC Insurance Accounts Receivable Report 364 Garden Ave., Holland, MI 49424-8656