NPIMap

Organization Active NPI

Core Activated Rehab 2 LLC

  • Chiropractor
  • Southlake, TX
National Provider Identifier
1104191709
Registry record updated Mar 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
11687 Issued in TX
Legal business name
CORE ACTIVATED REHAB 2 LLC
Practice address
1800 East Highway 114
Suite 101
Southlake, TX 76090
Phone
(985) 173-1173
NPI assigned
Mar 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2012

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

Authorized official

Name
Dr. Jason Mareno, D.C
Title
Partner
Phone
(985) 173-1173

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 11687 TX Primary

Addresses

Primary practice location

1800 East Highway 114
Suite 101
Southlake, TX 76090

Mailing address

1800 East Highway 114
Suite 101
Southlake, TX 76090
Phone (985) 173-1173

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331683200000",
    "number": "1104191709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 EAST HIGHWAY 114",
            "address_2": "SUITE 101",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76090",
            "telephone_number": "985-173-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 EAST HIGHWAY 114",
            "address_2": "SUITE 101",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76090",
            "telephone_number": "985-173-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE ACTIVATED REHAB 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-14",
        "last_updated": "2012-03-14",
        "status": "A",
        "authorized_official_last_name": "MARENO",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "985-173-1173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "11687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; 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.