Individual provider Active NPI

Ben Johnson, DC

  • Chiropractor
  • Cookeville, TN
National Provider Identifier
1164039459
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC3325 Issued in TN
Practice address
1265 Interstate Dr Ste 201B
Cookeville, TN 38501-5227
Phone
(931) 854-9254
NPI assigned
Sep 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 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 DC3325 TN Primary

Addresses

Primary practice location

1265 Interstate Dr Ste 201B
Cookeville, TN 38501-5227

Mailing address

5512 Old Hickory Blvd
Hermitage, TN 37076-2576
Phone (615) 942-7282

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250828005398 FL Practitioner - Chiropractic 2163834888 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1950 Laurel Manor Dr
Suite 204
The Villages, FL 32162-5602

421 NW 127TH St
Newberry, FL 32669-3012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC3325TNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
John C Theeck DC PA Chiropractor CurrentSince Aug 1, 2025 Accepting new patients

Locations

1950 Laurel Manor Dr
Ste 204
The Villages, FL 32162
Phone (352) 259-0024

Organizations & group practices 1

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": "1601424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1164039459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5512 OLD HICKORY BLVD",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370762576",
            "telephone_number": "615-942-7282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 INTERSTATE DR STE 201B",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385015227",
            "telephone_number": "931-854-9254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BEN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TN",
            "license": "DC3325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.