Active NPI
Petrina Jackson, DC
- Chiropractor
- Hazel Crest, IL
National Provider Identifier
1295377240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038.013330
- Practice address
- 17516 E Carriageway Dr Ste B
Hazel Crest, IL 60429-2079 - Phone
- (708) 260-6699
- Fax
- (708) 914-4393
- NPI assigned
- Oct 10, 2019
- Sex
- Female
- 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 | 038.013330 | IL | Primary |
Addresses
Primary practice location
17516 E Carriageway Dr Ste B
Hazel Crest, IL 60429-2079
Mailing address
17516 E Carriageway Dr Ste B
Hazel Crest, IL 60429-2079
Phone (708) 914-4445
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | info@triochiropractic.com | ||
| Direct Messaging Address | info@triochiropractic.com |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038.013330 | IL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672876800000",
"number": "1295377240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17516 E CARRIAGEWAY DR STE B",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292079",
"telephone_number": "708-914-4445",
"fax_number": "708-260-6699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17516 E CARRIAGEWAY DR STE B",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604292079",
"telephone_number": "708-260-6699",
"fax_number": "708-914-4393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PETRINA",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-10",
"last_updated": "2023-01-05",
"certification_date": "2023-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038.013330",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "info@triochiropractic.com",
"affiliation": "N",
"address_1": "17516 E Carriageway Dr Ste B",
"city": "Hazel Crest",
"state": "IL",
"country_code": "US",
"postal_code": "604292079",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "info@triochiropractic.com",
"affiliation": "N",
"endpointDescription": "Business Email",
"address_1": "17516 E Carriageway Dr Ste B",
"city": "Hazel Crest",
"state": "IL",
"country_code": "US",
"postal_code": "604292079",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Hazel Crest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.