Jacob Henricksen

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH14963 Issued in FL

Practice address

250 Crystal Grove Blvd
Lutz, FL 33548-6460

Phone

(813) 776-1480

Fax

(813) 807-4774

NPI assigned

Nov 30, 2016

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 FL

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Henricksen Chiropractic, LLC

  • Chiropractor
  • Lutz, FL
  • NPI 1346040425
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1194268771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3043 BOONES CREEK RD STE 107",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CRYSTAL GROVE BLVD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335486460",
            "telephone_number": "813-776-1480",
            "fax_number": "813-807-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRICKSEN",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-30",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH14963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Lee Heinig, M.D.
• Hunter Reece Heinlein, CAA
• Alison Hemsley, DO
• Jada Grace Henderson
• Henricksen Chiropractic, LLC
• Tristan D Hensley, DMD
• Mee Her
• Anabel Hernandez Rodriguez
• Chaletha Hernandez
• Elizabeth Sofia Hernandez

• Chiropractor in Lutz, FL
• Providers in Lutz, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.