NPIMap

Organization Active NPI

Southeastern Healthcare of Jacksonville, PC

  • Chiropractor
  • Jacksonville, NC
National Provider Identifier
1316090889
Registry record updated Oct 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3421 Issued in NC
Legal business name
SOUTHEASTERN HEALTHCARE OF JACKSONVILLE, PC
Practice address
431 Western Blvd
Suite E
Jacksonville, NC 28546-6823
Phone
(910) 355-6000
Fax
(910) 355-7533
NPI assigned
Jan 19, 2007
Organization subpart
Yes
Parent organization
SOUTHEASTERN HEALTHCARE OF JACKSONVILLEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2007

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

Authorized official

Name
Mrs. Eliza R. Gray
Title
Office Manager
Phone
(910) 791-2788

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3421 NC Primary

Addresses

Primary practice location

431 Western Blvd
Suite E
Jacksonville, NC 28546-6823

Mailing address

2595 S 17TH St
Wilmington, NC 28401-7748
Phone (910) 791-2788

National Provider Directory

National Provider Directory
Part of
Southeastern Hltcare

Locations

431 Western Blvd
Jacksonville, NC 28546
Phone (910) 355-6000

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191196800000",
    "number": "1316090889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017748",
            "telephone_number": "910-791-2788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 WESTERN BLVD",
            "address_2": "SUITE E",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466823",
            "telephone_number": "910-355-6000",
            "fax_number": "910-355-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN HEALTHCARE OF JACKSONVILLE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEASTERN HEALTHCARE OF JACKSONVILLE",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-10-01",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "910-791-2788",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.

Verify at the official NPI Registry.