Organization Active NPI

Northern Lights Chiropractic

  • Chiropractor
  • Watertown, NY
National Provider Identifier
1013158641
Registry record updated Nov 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X007976 Issued in NY
Legal business name
NORTHERN LIGHTS CHIROPRACTIC
Practice address
1116 Arsenal St
Watertown, NY 13601-2229
Phone
(315) 782-7166
Fax
(315) 782-0978
NPI assigned
Mar 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2009

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

Authorized official

Name
Rebecca Keshmiri, D.C.NPI 1336208883
Title
Owner/Director
Phone
(315) 782-7166

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X X007976 NY Primary

Addresses

Primary practice location

1116 Arsenal St
Watertown, NY 13601-2229

Mailing address

1116 Arsenal St
Suite 2
Watertown, NY 13601-2229
Phone (315) 782-7166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090721000350 NY Part B Supplier - Clinic/Group Practice 8921157116 Receives reassigned benefits from 3 practitioners
Practice locations: Watertown, NY

National Provider Directory

National Provider Directory

Locations

1116 Arsenal St
Ste 2
Watertown, NY 13601
Phone (315) 782-7166

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1236729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259020800000",
    "number": "1013158641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 ARSENAL ST",
            "address_2": "SUITE 2",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012229",
            "telephone_number": "315-782-7166",
            "fax_number": "315-782-0978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 ARSENAL ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012229",
            "telephone_number": "315-782-7166",
            "fax_number": "315-782-0978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIGHTS CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-11",
        "last_updated": "2009-11-24",
        "status": "A",
        "authorized_official_last_name": "KESHMIRI",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "315-782-7166",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X007976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.