Individual provider Active NPI

Jordan Craig White, D.C.

  • Chiropractor
  • San Antonio, TX
National Provider Identifier
1104937648
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4135 Issued in TX
Practice address
10008 Wurzbach Rd
San Antonio, TX 78230-2214
Phone
(210) 275-4600
Fax
(210) 855-3682
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4135 TX Primary

Addresses

Primary practice location

10008 Wurzbach Rd
San Antonio, TX 78230-2214

Mailing address

10008 Wurzbach Rd
San Antonio, TX 78230-2214
Phone (210) 275-4600

Other identifiers 1

IdentifierTypeStateIssuer
8H0000OtherTXBLUE BROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120328000325 TX Practitioner - Chiropractic 1951561083 Practice locations: San Antonio, TX

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10008 Wurzbach Rd
San Antonio, TX 78230-2214

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4135TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Good Chiropractic Chiropractor PastSince Apr 13, 2024 Accepting new patients
Canavan Center Chiropractic Health Clinic Chiropractor Past Accepting new patients
Colonies North Chiropractic Clinic Chiropractor Past Accepting new patients

Organizations & group practices 3

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1104937648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10008 WURZBACH RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782302214",
            "telephone_number": "210-275-4600",
            "fax_number": "210-855-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10008 WURZBACH RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782302214",
            "telephone_number": "210-275-4600",
            "fax_number": "210-855-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "JORDAN",
        "middle_name": "CRAIG",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "4135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE BROSS BLUE SHIELD",
            "identifier": "8H0000",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.