Active NPI
Jordan Davis, DC
- Chiropractor
- Libertyville, IL
National Provider Identifier
1215404090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038.013272
- Practice address
- 1785 Northwind Blvd
Libertyville, IL 60048-9617 - Phone
- (205) 412-4210
- NPI assigned
- Oct 30, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038.013272 | IL | Primary |
Addresses
Primary practice location
1785 Northwind Blvd
Libertyville, IL 60048-9617
Mailing address
1640 Lincoln Meadows Cir Apt 811
Schaumburg, IL 60173-6136
Phone (205) 412-4210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038.013272 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| One Goal Wellness, Inc | Chiropractor | Past | Accepting new patients |
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.
-
- Chiropractor
- Lake Villa, IL
- NPI 1861894081
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540857600000",
"number": "1215404090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 LINCOLN MEADOWS CIR APT 811",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601736136",
"telephone_number": "205-412-4210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1785 NORTHWIND BLVD",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600489617",
"telephone_number": "205-412-4210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JORDAN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-30",
"last_updated": "2018-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038.013272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.