Amanda Jackson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

15264 Issued in TX

Practice address

911 York Dr
Desoto, TX 75115-2063

Phone

(512) 897-4110

NPI assigned

Aug 30, 2022

Last updated

Aug 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

ChiropracticAlso: Neurology

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Portland Chiropractic Neurology, LLCGroup PAC ID 1759427776, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Portland Chiropractic Neurology, LLC

  • Neurology Chiropractor
  • Portland, ME
  • NPI 1780856336
  Medicare reassignment Care Compare group NPD
• Think Tank Hyperbarics

  dba New England Hyperbaric Oxygen

  • Multi-Specialty Clinic/Center
  • Portland, ME
  • NPI 1750271789
  NPD

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1215657242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 EVERGREEN CT",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483281",
            "telephone_number": "512-897-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 YORK DR",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152063",
            "telephone_number": "512-897-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANDA",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "15264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tesneem Issa, DO
• It's Magic Moments Lingerie
• J R Henderson & Associates, LLC
• J. L. E. Endless Possibilities, Inc.
• Jackson Support Services
• Diane Lynn Jackson
• Dianne Jackson
• Latasha Jackson
• Latricia Denise Jackson, APRN, FNP-BC
• Lee E Jackson

• Chiropractor in Desoto, TX
• Providers in Desoto, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.