Clint A Jackson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038010337 Issued in IL

Practice address

2912 Crossing CT
Champaign, IL 61822-6163

Phone

(217) 351-7746

Fax

(866) 204-2774

NPI assigned

Jun 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2004

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Jackson Chiropractic PC

  • Chiropractor
  • Champaign, IL
  • NPI 1982735536
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1174569834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2912 CROSSING COURT",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226163",
            "telephone_number": "217-351-7746",
            "fax_number": "866-204-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2912 CROSSING CT",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226163",
            "telephone_number": "217-351-7746",
            "fax_number": "866-204-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CLINT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2021-07-30",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiara Ivy
• J a K Enterprises Inc
• Jackson Chiropractic PC
• Rachel Jackson Green, MSW, LSW
• Ariel Tarnisha Nicole Jackson
• Jennifer Marie Jackson, RDH
• Susan Jackson, LCSW
• Laura Ann Jacob, R.D.
• Elaine Zeporah Jacobson, PH.D.
• Tejpalsinh Jadeja

• Chiropractor in Champaign, IL
• Providers in Champaign, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.