Active NPI
Jason Martin
- Chiropractor
- Rockford, IL
National Provider Identifier
1083210504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5483-12
- Practice address
- 6435 Weaver Rd
Rockford, IL 61114-8109 - Phone
- (815) 543-1549
- NPI assigned
- Dec 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5483-12 | WI | Primary |
Addresses
Primary practice location
6435 Weaver Rd
Rockford, IL 61114-8109
Mailing address
6435 Weaver Rd
Rockford, IL 61114-8109
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5483-12 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607472000000",
"number": "1083210504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6435 WEAVER RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611148109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6435 WEAVER RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611148109",
"telephone_number": "815-543-1549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-09",
"last_updated": "2020-12-09",
"certification_date": "2020-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "5483-12",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.