Active NPI
Kevin Jack, DC
- Chiropractor
- Durham, NC
National Provider Identifier
1124831706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5835
- Practice address
- 8202 Renaissance Pkwy Ste 108
Durham, NC 27713-6694 - Phone
- (919) 823-6384
- NPI assigned
- Jan 28, 2025
- Sex
- Male
- Sole proprietor
- No
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 | 5835 | NC | Primary |
Addresses
Primary practice location
8202 Renaissance Pkwy Ste 108
Durham, NC 27713-6694
Mailing address
107 Evening Star Drive
Apex, NC 27502
Phone (314) 243-7100
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 |
|---|---|---|---|
| 5835 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738022400000",
"number": "1124831706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 EVENING STAR DRIVE",
"city": "APEX",
"state": "NC",
"postal_code": "27502",
"telephone_number": "314-243-7100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8202 RENAISSANCE PKWY STE 108",
"city": "DURHAM",
"state": "NC",
"postal_code": "277136694",
"telephone_number": "919-823-6384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "KEVIN",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-28",
"last_updated": "2025-01-28",
"certification_date": "2025-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NC",
"license": "5835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.