Jack K Vandervort, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC001577L Issued in PA

Practice address

11581 State Hwy 98
Meadville, PA 16335-7321

Phone

(814) 336-3434

Fax

(814) 337-8767

NPI assigned

Apr 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Iadeluca Chiropractic Center Corry PC

  • Chiropractor
  • Corry, PA
  • NPI 1275115552
  NPD (past)

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271203200000",
    "number": "1124082599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11581 STATE HWY 98",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163357321",
            "telephone_number": "814-336-3434",
            "fax_number": "814-337-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11581 STATE HWY 98",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163357321",
            "telephone_number": "814-336-3434",
            "fax_number": "814-337-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERVORT",
        "first_name": "JACK",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2010-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC001577L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006316630002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Meadville, PA
• Providers in Meadville, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; 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.