Individual provider Active NPI

Jonathan Owen Nordstrom, D.C.

  • Chiropractor
  • Edmond, OK
National Provider Identifier
1043484793
Registry record updated Aug 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3867 Issued in OK
Practice address
800 W 18TH St
Suite 120
Edmond, OK 73013-3758
Phone
(405) 286-0322
Fax
(405) 285-7034
NPI assigned
Apr 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3867 OK Primary

Addresses

Primary practice location

800 W 18TH St
Suite 120
Edmond, OK 73013-3758

Mailing address

800 W 18TH St
Ste. 120
Edmond, OK 73013-3758
Phone (405) 286-0322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3867OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lance Doyle DC PC CurrentSince May 6, 2019 Accepting new patients
Advanced Chiropractic and Rehabilitation Clinic P L L C PastSince Oct 28, 2017 Accepting new patients

Locations

1050 W Vandament Ave
Yukon, OK 73099
Phone (405) 354-5753

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407974400000",
    "number": "1043484793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W 18TH ST",
            "address_2": "STE. 120",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133758",
            "telephone_number": "405-286-0322",
            "fax_number": "405-285-7034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W 18TH ST",
            "address_2": "SUITE 120",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133758",
            "telephone_number": "405-286-0322",
            "fax_number": "405-285-7034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDSTROM",
        "first_name": "JONATHAN",
        "middle_name": "OWEN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-14",
        "last_updated": "2014-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.