Active NPI
Nicholas Austin Lightfoot
- Chiropractor
- Bloomington, IN
National Provider Identifier
1245451442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 08001909A
- Practice address
- 532 N Walnut St
Ste. B
Bloomington, IN 47404-3809 - Phone
- (812) 333-9404
- Fax
- (812) 333-2152
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 08001909A | IN | Primary |
Addresses
Primary practice location
532 N Walnut St
Ste. B
Bloomington, IN 47404-3809
Mailing address
532 N Walnut St
Ste. B
Bloomington, IN 47404-3809
Phone (812) 333-9404
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000079774 | Other | IN | ANTHEM BLUE CROSS |
| 200270020A | Medicaid | IN |
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 |
|---|---|---|---|
| 08001909A | IN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245451442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "532 N WALNUT ST",
"address_2": "STE. B",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474043809",
"telephone_number": "812-333-9404",
"fax_number": "812-333-2152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "532 N WALNUT ST",
"address_2": "STE. B",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474043809",
"telephone_number": "812-333-9404",
"fax_number": "812-333-2152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHTFOOT",
"first_name": "NICHOLAS",
"middle_name": "AUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IN",
"license": "08001909A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "000000079774",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200270020A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.