The Injury Clinic of Ft Myers LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

THE INJURY CLINIC OF FT MYERS LLC

Practice address

12640 World Plaza LN
Fort Myers, FL 33907-3987

Phone

(239) 689-8488

Fax

(239) 243-8149

NPI assigned

Feb 17, 2022

Organization subpart

No

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

Authorized official

Name

Jacy Bloom, DC

Title

Chiropractor

Phone

(239) 689-8488

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1154076222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9858 CLINT MOORE RD # C111-274",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334961034",
            "telephone_number": "561-482-1144",
            "fax_number": "561-482-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12640 WORLD PLAZA LN",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073987",
            "telephone_number": "239-689-8488",
            "fax_number": "239-243-8149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE INJURY CLINIC OF FT MYERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-17",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "JACY",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "239-689-8488",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "KAREO",
            "affiliation": "N",
            "endpointDescription": "KAREO",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "HEALTH RECORDS",
            "address_1": "12640 World Plaza Ln",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339073987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.