Individual provider Active NPI

Jeb Robertson Thurmond, DC

  • Chiropractor
  • Keene, NH
National Provider Identifier
1104040799
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
180-0494 Issued in NH
Practice address
640 Marlboro St Ste 1
Keene, NH 03431-4049
Phone
(603) 313-0617
Fax
(855) 461-3277
NPI assigned
Apr 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 180-0494 NH Primary

Addresses

Primary practice location

640 Marlboro St Ste 1
Keene, NH 03431-4049

Mailing address

640 Marlboro St
Keene, NH 03431-4049
Phone (603) 313-0617

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041210000151 NH Practitioner - Chiropractic 6103728373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Los Angeles College of Chiropractic, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

640 Marlboro St
Keene, NH 03431-4049
Phone (603) 338-0231

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180-0494NHMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Evolution Chiropractic LLC Chiropractor CurrentSince Jan 1, 2003 Accepting new patients

Locations

640 Marlboro St
Ste 1
Keene, NH 03431
Phone (603) 313-0617

415 Marlboro St
Keene, NH 03431
Phone (603) 313-0617

391 West St
Keene, NH 03431
Phone (603) 357-0677

640 Marlboro St
Keene, NH 03431
Phone (603) 313-0617

Organizations & group practices 1

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": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683072000000",
    "number": "1104040799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 MARLBORO ST",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034314049",
            "telephone_number": "603-313-0617",
            "fax_number": "855-461-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 MARLBORO ST STE 1",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034314049",
            "telephone_number": "603-313-0617",
            "fax_number": "855-461-3277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THURMOND",
        "first_name": "JEB",
        "middle_name": "ROBERTSON",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NH",
            "license": "180-0494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keene, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.