Garrell Keithe Jackson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

20634 Issued in CA

Practice address

3330 Cameron Park Dr Ste 200
Cameron Park, CA 95682-7652

Phone

(530) 621-4803

Fax

(530) 621-2450

NPI assigned

Jun 16, 2005

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 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

Los Angeles College of Chiropractic, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson Chiropractic Inc

  • Chiropractor
  • Cameron Park, CA
  • NPI 1164594867
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1326043399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 MISSOURI FLAT RD",
            "address_2": "STE 1E",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956676808",
            "telephone_number": "530-621-4803",
            "fax_number": "530-621-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 CAMERON PARK DR STE 200",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956827652",
            "telephone_number": "530-621-4803",
            "fax_number": "530-621-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "GARRELL",
        "middle_name": "KEITHE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "20634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD",
            "identifier": "DC0206340",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD",
            "identifier": "ZZZ61178Z",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Placerville",
            "affiliation": "Y",
            "affiliationName": "Jackson Chiropractic Inc",
            "address_1": "3330 Cameron Park Dr Ste 200",
            "city": "Cameron Park",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956827652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Innovative Treatment Associates
• Innovative Treatment Associates Inc
• Lianne Chiemi Inouye, O.D.
• Kristopher T. Isaacs, P.T.
• Jackson Chiropractic Inc
• Russell F Jacoby, MD
• Nahvid Jafarnejad, DMD
• Miranda Jiminez
• Ying Jin, RPH
• John E. Roe, PH.D., a Professional Corporation

• Chiropractor in Cameron Park, CA
• Providers in Cameron Park, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.