Jack a Pedersen Hurst Chiropractic Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2471 Issued in TX

Legal business name

JACK A PEDERSEN HURST CHIROPRACTIC CENTER

Practice address

7155 Colleyville Blvd
Ste 103
Colleyville, TX 76034-8003

Phone

(817) 251-7328

Fax

(817) 421-7380

NPI assigned

Oct 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jack A Pedersen, D.C.NPI 1164484895

Title

Owner

Phone

(817) 251-7328

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack A Pedersen, D.C.

  • Chiropractor
  • Colleyville, TX
  • NPI 1164484895
  NPD (past) Authorized official

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1275712267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7155 COLLEYVILLE BLVD",
            "address_2": "STE 103",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760348003",
            "telephone_number": "817-251-7328",
            "fax_number": "817-421-7380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7155 COLLEYVILLE BLVD",
            "address_2": "STE 103",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760348003",
            "telephone_number": "817-251-7328",
            "fax_number": "817-421-7380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK A PEDERSEN HURST CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-26",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-251-7328",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "2471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS INDIVIDUAL ID",
            "identifier": "80K571",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP ID",
            "identifier": "00F40Y",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1164484895",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.