Steven Bruce Jackson, D.C, D.A.B.C.O

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

1788 Issued in MN

Practice address

3508 Rice St
Saint Paul, MN 55126-3170

Phone

(651) 483-4321

Fax

(651) 483-3440

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practitioners 1

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

• Maya Ann Ezer, D.C.

  • Chiropractor
  • Saint Paul, MN
  • NPI 1306483052
  Medicare reassignment

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318636800000",
    "number": "1285722512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3508 RICE ST",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551265002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3508 RICE ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551263170",
            "telephone_number": "651-483-4321",
            "fax_number": "651-483-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEVEN",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "D.C, D.A.B.C.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2011-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "MN",
            "license": "1788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433527900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristina Jackson, LPCC
• Leah Jackson
• Melissa Jackson, RN
• Michael Doniel Jackson, M.D
• Paige Taylor Aubriana Jackson, RN
• Annette L Jacob, LICSW
• Therese Jacobs-Stewart, MA, LP
• Delle Marian Jacobs, MSW, LICSW, LMFT
• Emily Jacobs, LPCC
• Jesse Jacobs

• Orthopedic Chiropractor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Orthopedic Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.