Jackson Chiropractic Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

20634 Issued in CA

Legal business name

JACKSON CHIROPRACTIC INC

Practice address

3330 Cameron Park Dr Ste 200
Cameron Park, CA 95682-7652

Phone

(530) 621-4803

Fax

(530) 621-2450

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Garrell Keithe Jackson, D.C.NPI 1326043399

Title

President

Phone

(530) 621-4803

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Garrell Keithe Jackson, DC

  • Chiropractor
  • Cameron Park, CA
  • NPI 1326043399
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620864000000",
    "number": "1164594867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 CAMERON PARK DR STE 200",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956827652",
            "telephone_number": "530-621-4803",
            "fax_number": "530-621-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 CAMERON PARK DR STE 200",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956827652",
            "telephone_number": "530-621-4803",
            "fax_number": "530-621-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GARRELL",
        "authorized_official_middle_name": "KEITHE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "530-621-4803",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "20634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "DCO206340",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ61178Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Infant Parent Center
• Innovative Treatment Associates
• Innovative Treatment Associates Inc
• Lianne Chiemi Inouye, O.D.
• Kristopher T. Isaacs, P.T.
• Garrell Keithe Jackson, DC
• Russell F Jacoby, MD
• Nahvid Jafarnejad, DMD
• Miranda Jiminez
• Ying Jin, RPH

• Chiropractor in Cameron Park, CA
• Providers in Cameron Park, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.