NPIMap

Organization Active NPI

Progressive Chiropractic and Rehabilitation

  • Chiropractor
  • Crestview, FL
National Provider Identifier
1053730218
Registry record updated Apr 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH9929 Issued in FL
Legal business name
PROGRESSIVE CHIROPRACTIC AND REHABILITATION
Practice address
502 S Main St
Crestview, FL 32536-4250
Phone
(850) 398-8640
Fax
(850) 398-8641
NPI assigned
Apr 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2014

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

Authorized official

Name
Dr. Joel A. Tate, D.C.NPI 1962726703
Title
Chiropractic Physician/Owner
Phone
(309) 830-9694

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 CH9929 FL Primary

Addresses

Primary practice location

502 S Main St
Crestview, FL 32536-4250

Mailing address

502 S Main St
Crestview, FL 32536-4250
Phone (850) 398-8640

Other identifiers 2

IdentifierTypeStateIssuer
CH9929OtherFLMEDICAL LICENSE
220C0OtherFLBLUE CROSS BLUE SHIELD PROVIDER NUMBER

National Provider Directory

National Provider Directory

Locations

502 S Main St
Crestview, FL 32536
Phone (850) 398-8640

Practitioners & affiliated clinicians

Practitioners 1

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": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397520000000",
    "number": "1053730218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S MAIN ST",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325364250",
            "telephone_number": "850-398-8640",
            "fax_number": "850-398-8641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S MAIN ST",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325364250",
            "telephone_number": "850-398-8640",
            "fax_number": "850-398-8641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE CHIROPRACTIC AND REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2014-04-15",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIROPRACTIC PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "309-830-9694",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "CH9929",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PROVIDER NUMBER",
            "identifier": "220C0",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.