NPIMap

Organization Active NPI

Ethos Regenerative Medical Group PLLC

  • Chiropractor
  • Irving, TX
National Provider Identifier
1306016282
Registry record updated May 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
8277 Issued in TX
Legal business name
ETHOS REGENERATIVE MEDICAL GROUP PLLC
Practice address
300 E. Royal LN
Suite 110
Irving, TX 75039
Phone
(972) 409-0016
Fax
(972) 409-0013
NPI assigned
Mar 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2019

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

Authorized official

Name
Dr. Jason Cory Black, D.C.
Title
Owner
Phone
(972) 409-0016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 8277 TX Primary

Addresses

Primary practice location

300 E. Royal LN
Suite 110
Irving, TX 75039

Mailing address

300 E. Royal LN
Suite 110
Irving, TX 75039
Phone (972) 409-0016

National Provider Directory

National Provider Directory

Locations

300 E Royal Ln
Ste 110
Irving, TX 75039
Phone (972) 409-0016

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558310400000",
    "number": "1306016282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E. ROYAL LN",
            "address_2": "SUITE 110",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "75039",
            "telephone_number": "972-409-0016",
            "fax_number": "972-409-0013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E. ROYAL LN",
            "address_2": "SUITE 110",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "75039",
            "telephone_number": "972-409-0016",
            "fax_number": "972-409-0013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHOS REGENERATIVE MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2019-05-20",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "CORY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-409-0016",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "8277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; 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.