NPIMap

Organization Active NPI

Dr Jordan DC Greenlight Chiropractic Lake Forest Ca PC

Doing business as Greenlight Chiropractic & Wellness Lab

  • Pediatric Chiropractor
  • Lake Forest, CA
National Provider Identifier
1063295392
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric ChiropractorTaxonomy code 111NP0017X
Legal business name
DR JORDAN DC GREENLIGHT CHIROPRACTIC LAKE FOREST CA PC
Doing business as
Greenlight Chiropractic & Wellness Lab
Practice address
23101 Lake Center Dr Ste 110
Lake Forest, CA 92630-2882
Phone
(949) 586-2731
NPI assigned
Aug 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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

Authorized official

Name
Dr. Jordan Ziegler, DCNPI 1023767324
Title
Doctor of Chiropractic
Phone
(719) 321-6308

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NN1001X
Pediatric ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NP0017X Primary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X
Orthopedic ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NX0800X

Addresses

Primary practice location

23101 Lake Center Dr Ste 110
Lake Forest, CA 92630-2882

Mailing address

PO Box 3265
Rancho Santa Fe, CA 92067-3265

Other names 1

  • Greenlight Chiropractic & Wellness Lab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231016000617 CA Part B Supplier - Clinic/Group Practice 3274988092 Receives reassigned benefits from 6 practitioners
Practice locations: Lake Forest, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1063295392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3265",
            "city": "RANCHO SANTA FE",
            "state": "CA",
            "postal_code": "920673265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23101 LAKE CENTER DR STE 110",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302882",
            "telephone_number": "949-586-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JORDAN DC GREENLIGHT CHIROPRACTIC LAKE FOREST CA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "ZIEGLER",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "719-321-6308",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111NX0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenlight Chiropractic & Wellness Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.